1
|
Javurkova A, Zivnustka M, Brezinova T, Raudenska J, Zarubova J, Marusic P. Neurocognitive profile in patients with idiopathic generalized epilepsies: Differences between patients, their biological siblings, and healthy controls. Epilepsy Behav 2023; 142:109204. [PMID: 37086591 DOI: 10.1016/j.yebeh.2023.109204] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2022] [Revised: 03/25/2023] [Accepted: 03/26/2023] [Indexed: 04/24/2023]
Abstract
BACKGROUND Idiopathic generalized epilepsy (IGE) is one of the most common epilepsies and is believed to have a strong genetic origin. Patients with IGE present largely heterogeneous neurocognitive profiles and might show some neurocognitive impairments. Furthermore, IGE siblings may demonstrate worse results in neuropsychological tests as well. In our study, we aimed to map the neurocognitive profile both in patients with IGE and the siblings. We also sought to establish a neurocognitive profile for each IGE syndrome. METHODS The research sample included 110 subjects (IGE n = 46, biological siblings BS n = 16, and healthy controls n = 48) examined. Subjects were neuropsychologically examined in domains of intelligence, attention, memory, executive, and motor functions. The data obtained from the examination were statistically processed to determine whether and how IGE patients (including distinct syndromes) and the siblings differed neurocognitively from healthy controls (adjusted z-scores by age, education, and gender, and composite z-scores of cognitive domains). Data on anti-seizure medication, including defined daily doses, were obtained and included in the analysis. RESULTS IGE patients and their biological siblings performed significantly worse in most of the neuropsychological tests than healthy controls. The neurocognitive profile of composite z-scores showed that IGE and biological siblings had equally significantly impaired performance in executive functions. IGE group also demonstrated impaired composite attention and motor function scores. The profile of individual IGE syndromes showed that JAE, JME, and EGTCS had significantly worse performance in composite execution score and motor function score. JAE presented significantly worse performance in intelligence and attention. JME exhibited significantly worse composite score in the attention domain. Anti-seizure medication, depression, and quality of life were unrelated to cognitive performance in IGE group. The level of depression significantly predicted the overall value of quality of life in patients with IGE, while cognitive domains, sociodemographic, and clinical factors were unrelated. CONCLUSION Our study highlights the importance to consider the neurocognitive profile of IGE patients that can lead to difficulties in their education, acceptance, and management of coping strategies. Cognitive difficulties of IGE siblings could support a hypothesis that these impairments emerge from heritable traits.
Collapse
Affiliation(s)
- A Javurkova
- Department of Neurology, Second Faculty of Medicine, Charles University and Motol University Hospital, Prague, Czech Republic; Department of Nursing, Second Faculty of Medicine, Charles University and Motol University Hospital, Prague, Czech Republic.
| | - M Zivnustka
- Department of Neurology, Second Faculty of Medicine, Charles University and Motol University Hospital, Prague, Czech Republic.
| | - T Brezinova
- Department of Clinical Neuropsychology, University of Groningen, Netherlands.
| | - J Raudenska
- Department of Nursing, Second Faculty of Medicine, Charles University and Motol University Hospital, Prague, Czech Republic.
| | - J Zarubova
- Department of Neurology, Second Faculty of Medicine, Charles University and Motol University Hospital, Prague, Czech Republic.
| | - P Marusic
- Department of Neurology, Second Faculty of Medicine, Charles University and Motol University Hospital, Prague, Czech Republic.
| |
Collapse
|
2
|
Al Saedi A, Kirk B, Iuliano S, Zanker J, Vogrin S, Jayaram L, Thomas S, Golding C, Navarro-Perez D, Marusic P, Leng S, Nanan R, Duque G. Effects of 3 months of multi-nutrient supplementation on the immune system and muscle and respiratory function of older adults in aged care (The Pomerium Study): protocol for a randomised controlled trial. BMJ Open 2022; 12:e059075. [PMID: 35523505 PMCID: PMC9082724 DOI: 10.1136/bmjopen-2021-059075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
INTRODUCTION Immunosenescence leads to increased morbidity and mortality associated with viral infections and weaker vaccine responses. This has been well documented for seasonal influenza and the current pandemic with SARS-CoV-2 (COVID-19), which disproportionately impact older adults, particularly those in residential aged care facilities. Inadequate nutrient intakes associated with impaired immunity, respiratory and muscle function are likely to augment the effects of immunosenescence. In this study, we test whether the impact of inadequate nutrition can be reversed using multi-nutrient supplementation, consequently enhancing vaccine responses, reducing the risk of viral infections and improving respiratory and muscle function. METHODS AND ANALYSIS The Pomerium Study is a 3-month, single-blind, randomised, controlled trial testing the effects of two daily servings of an oral multi-nutrient supplement (330 kcal, 20 g protein, 1.5 g calcium 3-hydroxy-3-methylbutyrate monohydrate (CaHMB), 449 mg calcium, 500 IU vitamin D3 and 25 vitamins and minerals) on the immune system and muscle and respiratory function of older adults in aged care in Melbourne, Australia. 160 older adults (≥75 years old) will be recruited from aged care facilities and randomised to treatment (multi-nutrient supplement) or control (usual care). The primary outcome is a change in T-cell subsets CD8 + and CD28null counts at months 1 and 3. Secondary outcomes measured at baseline and month 3 are multiple markers of immunosenescence (also at 1 month), body composition (bioimpedance), handgrip strength (dynamometer), physical function (short physical performance battery), respiratory function (spirometry) and quality of life (EQ-5D-5L). Incidence and complications of COVID-19 and/or viral infections (ie, hospitalisation, complications or death) will be recorded throughout the trial, including 3 months after supplementation is ceased. ETHICS AND DISSEMINATION This study was approved by Melbourne Health Human Research Ethics Committee (Ref No. HREC/73985/MH-2021, ERM Ref No. RMH73985, Melbourne Health Site Ref No. 2021.115). Written informed consent will be obtained from participants. Results will be published in peer-reviewed journals and made available to key aged care stakeholders, including providers, residents, and government bodies. TRIAL REGISTRATION NUMBER ACTRN12621000420842.
Collapse
Affiliation(s)
- Ahmed Al Saedi
- Medicine-Western Health, The University of Melbourne, Melbourne, Victoria, Australia
- Australian Institute for Musculoskeletal Science (AIMSS), St Albans, Victoria, Australia
| | - Ben Kirk
- Medicine-Western Health, The University of Melbourne, Melbourne, Victoria, Australia
- Australian Institute for Musculoskeletal Science (AIMSS), St Albans, Victoria, Australia
| | - Sandra Iuliano
- Medicine-Western Health, The University of Melbourne, Melbourne, Victoria, Australia
- Australian Institute for Musculoskeletal Science (AIMSS), St Albans, Victoria, Australia
| | - Jesse Zanker
- Medicine-Western Health, The University of Melbourne, Melbourne, Victoria, Australia
- Australian Institute for Musculoskeletal Science (AIMSS), St Albans, Victoria, Australia
| | - Sara Vogrin
- Medicine-Western Health, The University of Melbourne, Melbourne, Victoria, Australia
- Australian Institute for Musculoskeletal Science (AIMSS), St Albans, Victoria, Australia
| | - Lata Jayaram
- Medicine-Western Health, The University of Melbourne, Melbourne, Victoria, Australia
| | - Shane Thomas
- Australian Institute for Musculoskeletal Science (AIMSS), St Albans, Victoria, Australia
| | - Christine Golding
- School of Population and Global Health, The University of Melbourne, Melbourne, Victoria, Australia
| | - Diana Navarro-Perez
- Medicine-Western Health, The University of Melbourne, Melbourne, Victoria, Australia
- Australian Institute for Musculoskeletal Science (AIMSS), St Albans, Victoria, Australia
| | - Petra Marusic
- Australian Institute for Musculoskeletal Science (AIMSS), St Albans, Victoria, Australia
| | - Sean Leng
- Johns Hopkins Center on Aging and Immune Remodeling, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Ralph Nanan
- Nepean Clinical School, The University of Sydney, Sydney, New South Wales, Australia
| | - Gustavo Duque
- Medicine-Western Health, The University of Melbourne, Melbourne, Victoria, Australia
- Australian Institute for Musculoskeletal Science (AIMSS), St Albans, Victoria, Australia
| |
Collapse
|
3
|
Zaldivia MTK, Hering D, Marusic P, Sata Y, Lee R, Esler MD, Htun NM, Duval J, Hammond L, Flierl U, Wang X, Drummond GR, Walton A, Gardiner EE, Andrews RK, Schlaich MP, Peter K. Successful renal denervation decreases the platelet activation status in hypertensive patients. Cardiovasc Res 2020; 116:202-210. [PMID: 30715163 DOI: 10.1093/cvr/cvz033] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2018] [Revised: 12/18/2018] [Accepted: 01/31/2019] [Indexed: 12/23/2022] Open
Abstract
AIMS To determine whether renal denervation (RDN) in hypertensive patients affects the platelet activation status. METHODS AND RESULTS We investigated the effect of RDN on the platelet activation status in 41 hypertensive patients undergoing RDN. Ambulatory blood pressure (BP), plasma sympathetic neurotransmitter Neuropeptide Y, and platelet activation markers were measured at baseline, at 3 months, and 6 months after RDN. RDN significantly decreased BP at 3 months (150.6 ± 11.3/80.9 ± 11.4 mmHg to 144.7 ± 12.0/77.1 ± 11.1 mmHg; P < 0.01) and at 6 months (144.3 ± 13.8/78.3 ± 11.1 mmHg; P < 0.01). Plasma levels of the sympathetic neurotransmitter Neuropeptide Y, an indicator of sympathetic nerve activity, were significantly decreased at 3 months (0.29 ± 0.11 ng/mL to 0.23 ± 0.11 ng/mL; P < 0.0001) and at 6 months (0.22 ± 0.12 ng/mL; P < 0.001) after RDN. This was associated with a reduction in platelet membrane P-selectin expression (3 months, P < 0.05; 6 months, P < 0.05), soluble P-selectin (6 months, P < 0.05), circulating numbers of platelet-derived extracellular vesicles (EVs) (3 months, P < 0.001; 6 months, P < 0.01), and phosphatidylserine expressing EVs (3 months, P < 0.001; 6 months, P < 0.0001), indicative of a reduction in platelet activation status and procoagulant activity. Only patients who responded to RDN with a BP reduction showed inhibition of P-selectin expression at 3 months (P < 0.05) and 6 months (P < 0.05) as well as reduction of glycoprotein IIb/IIIa activation at 3 months (P < 0.05). Notably, 13 patients who took aspirin did not show significant reduction in platelet P-selectin expression following RDN. CONCLUSION Our results imply a connection between the sympathetic nervous system and the platelet activation status and provide a potential mechanistic explanation by which RDN can have favourable effects towards reducing cardiovascular complications.
Collapse
Affiliation(s)
- Maria T K Zaldivia
- Atherothrombosis and Vascular Biology, Baker Heart and Diabetes Institute, 75 Commercial Road, Melbourne, VIC 3004, Australia.,Department of Medicine, Monash University, Melbourne, Australia
| | - Dagmara Hering
- Neurovascular Hypertension and Kidney Disease, Baker Heart and Diabetes Institute, Melbourne, Australia.,Dobney Hypertension Centre, School of Medicine, Royal Perth Hospital Unit, University of Western Australia, Perth, Australia
| | - Petra Marusic
- Neurovascular Hypertension and Kidney Disease, Baker Heart and Diabetes Institute, Melbourne, Australia.,Dobney Hypertension Centre, School of Medicine, Royal Perth Hospital Unit, University of Western Australia, Perth, Australia
| | - Yusuke Sata
- Neurovascular Hypertension and Kidney Disease, Baker Heart and Diabetes Institute, Melbourne, Australia
| | - Rebecca Lee
- Neurovascular Hypertension and Kidney Disease, Baker Heart and Diabetes Institute, Melbourne, Australia
| | - Murray D Esler
- Department of Medicine, Monash University, Melbourne, Australia.,Heart Centre, Alfred Hospital, Melbourne, Australia
| | - Nay M Htun
- Atherothrombosis and Vascular Biology, Baker Heart and Diabetes Institute, 75 Commercial Road, Melbourne, VIC 3004, Australia.,Heart Centre, Alfred Hospital, Melbourne, Australia
| | - Jacqueline Duval
- Neurovascular Hypertension and Kidney Disease, Baker Heart and Diabetes Institute, Melbourne, Australia
| | - Louise Hammond
- Neurovascular Hypertension and Kidney Disease, Baker Heart and Diabetes Institute, Melbourne, Australia
| | - Ulrike Flierl
- Atherothrombosis and Vascular Biology, Baker Heart and Diabetes Institute, 75 Commercial Road, Melbourne, VIC 3004, Australia
| | - Xiaowei Wang
- Atherothrombosis and Vascular Biology, Baker Heart and Diabetes Institute, 75 Commercial Road, Melbourne, VIC 3004, Australia.,Department of Medicine, Monash University, Melbourne, Australia
| | - Grant R Drummond
- Department of Physiology, Anatomy and Microbiology, School of Life Sciences, La Trobe University, Bundoora, Australia
| | - Antony Walton
- Department of Medicine, Monash University, Melbourne, Australia.,Heart Centre, Alfred Hospital, Melbourne, Australia
| | - Elizabeth E Gardiner
- ACRF Department of Cancer Biology and Therapeutics, John Curtin School of Medical Research, Australian National University, Canberra, Australia
| | - Robert K Andrews
- Department of Medicine, Monash University, Melbourne, Australia.,Australian Centre for Blood Diseases, Monash University, Melbourne, Australia
| | - Markus P Schlaich
- Department of Medicine, Monash University, Melbourne, Australia.,Neurovascular Hypertension and Kidney Disease, Baker Heart and Diabetes Institute, Melbourne, Australia.,Dobney Hypertension Centre, School of Medicine, Royal Perth Hospital Unit, University of Western Australia, Perth, Australia.,Heart Centre, Alfred Hospital, Melbourne, Australia
| | - Karlheinz Peter
- Atherothrombosis and Vascular Biology, Baker Heart and Diabetes Institute, 75 Commercial Road, Melbourne, VIC 3004, Australia.,Department of Medicine, Monash University, Melbourne, Australia.,Heart Centre, Alfred Hospital, Melbourne, Australia
| |
Collapse
|
4
|
Hofman MS, Lawrentschuk N, Francis RJ, Tang C, Vela I, Thomas P, Rutherford N, Martin JM, Frydenberg M, Shakher R, Wong LM, Taubman K, Ting Lee S, Hsiao E, Roach P, Nottage M, Kirkwood I, Hayne D, Link E, Marusic P, Matera A, Herschtal A, Iravani A, Hicks RJ, Williams S, Murphy DG. Prostate-specific membrane antigen PET-CT in patients with high-risk prostate cancer before curative-intent surgery or radiotherapy (proPSMA): a prospective, randomised, multicentre study. Lancet 2020; 395:1208-1216. [PMID: 32209449 DOI: 10.1016/s0140-6736(20)30314-7] [Citation(s) in RCA: 950] [Impact Index Per Article: 237.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2020] [Revised: 02/02/2020] [Accepted: 02/04/2020] [Indexed: 12/27/2022]
Abstract
BACKGROUND Conventional imaging using CT and bone scan has insufficient sensitivity when staging men with high-risk localised prostate cancer. We aimed to investigate whether novel imaging using prostate-specific membrane antigen (PSMA) PET-CT might improve accuracy and affect management. METHODS In this multicentre, two-arm, randomised study, we recruited men with biopsy-proven prostate cancer and high-risk features at ten hospitals in Australia. Patients were randomly assigned to conventional imaging with CT and bone scanning or gallium-68 PSMA-11 PET-CT. First-line imaging was done within 21 days following randomisation. Patients crossed over unless three or more distant metastases were identified. The primary outcome was accuracy of first-line imaging for identifying either pelvic nodal or distant-metastatic disease defined by the receiver-operating curve using a predefined reference-standard including histopathology, imaging, and biochemistry at 6-month follow-up. This trial is registered with the Australian New Zealand Clinical Trials Registry, ANZCTR12617000005358. FINDINGS From March 22, 2017 to Nov 02, 2018, 339 men were assessed for eligibility and 302 men were randomly assigned. 152 (50%) men were randomly assigned to conventional imaging and 150 (50%) to PSMA PET-CT. Of 295 (98%) men with follow-up, 87 (30%) had pelvic nodal or distant metastatic disease. PSMA PET-CT had a 27% (95% CI 23-31) greater accuracy than that of conventional imaging (92% [88-95] vs 65% [60-69]; p<0·0001). We found a lower sensitivity (38% [24-52] vs 85% [74-96]) and specificity (91% [85-97] vs 98% [95-100]) for conventional imaging compared with PSMA PET-CT. Subgroup analyses also showed the superiority of PSMA PET-CT (area under the curve of the receiver operating characteristic curve 91% vs 59% [32% absolute difference; 28-35] for patients with pelvic nodal metastases, and 95% vs 74% [22% absolute difference; 18-26] for patients with distant metastases). First-line conventional imaging conferred management change less frequently (23 [15%] men [10-22] vs 41 [28%] men [21-36]; p=0·008) and had more equivocal findings (23% [17-31] vs 7% [4-13]) than PSMA PET-CT did. Radiation exposure was 10·9 mSv (95% CI 9·8-12·0) higher for conventional imaging than for PSMA PET-CT (19·2 mSv vs 8·4 mSv; p<0·001). We found high reporter agreement for PSMA PET-CT (κ=0·87 for nodal and κ=0·88 for distant metastases). In patients who underwent second-line image, management change occurred in seven (5%) of 136 patients following conventional imaging, and in 39 (27%) of 146 following PSMA PET-CT. INTERPRETATION PSMA PET-CT is a suitable replacement for conventional imaging, providing superior accuracy, to the combined findings of CT and bone scanning. FUNDING Movember and Prostate Cancer Foundation of Australia. VIDEO ABSTRACT.
Collapse
Affiliation(s)
- Michael S Hofman
- Molecular Imaging and Therapeutic Nuclear Medicine, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia; Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, VIC, Australia.
| | - Nathan Lawrentschuk
- Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, VIC, Australia; Department of Surgery, Austin Health, Melbourne, VIC, Australia; Urological Society of Australia and New Zealand, NSW, Australia
| | - Roslyn J Francis
- Department of Nuclear Medicine, Sir Charles Gairdner Hospital, Perth, WA, Australia; University of Western Australia, Faculty of Health and Medical Sciences, Perth, WA, Australia; ARTnet, NSW, Australia
| | - Colin Tang
- Department of Radiation Oncology, Sir Charles Gairdner Hospital, Perth, Australia
| | - Ian Vela
- Department of Urology, Princess Alexandra Hospital, Australian Prostate Cancer Research Centre-Queensland, Queensland University of Technology, Translational Research Institute, Brisbane, QLD, Australia
| | - Paul Thomas
- Department of Nuclear Medicine, Royal Brisbane and Women's Hospital, Brisbane, QLD, Australia; Faculty of Medicine, University of Queensland, Brisbane, QLD, Australia
| | - Natalie Rutherford
- Department of Nuclear Medicine, Hunter New England Health, Newcastle, NSW, Australia
| | - Jarad M Martin
- School of Medicine and Public Health, University of Newcastle, Newcastle, NSW, Australia
| | - Mark Frydenberg
- Department of Surgery, Monash University and Cabrini Institute, Cabrini Health, Melbourne, VIC, Australia
| | - Ramdave Shakher
- Monash Health Imaging, Monash Health, Melbourne, VIC, Australia
| | - Lih-Ming Wong
- Department of Urology and Surgery, St Vincent's Health Melbourne, University of Melbourne, Melbourne, VIC, Australia
| | - Kim Taubman
- Department of Medical Imaging, PET/CT and St Vincent's Private Radiology, St Vincent's Health, Melbourne, VIC, Australia
| | - Sze Ting Lee
- Department of Molecular Imaging and Therapy, Austin Health, Melbourne, VIC, Australia
| | - Edward Hsiao
- University of Sydney, Department of Nuclear Medicine and PET, Royal North Shore Hospital, Sydney, NSW, Australia
| | - Paul Roach
- University of Sydney, Department of Nuclear Medicine and PET, Royal North Shore Hospital, Sydney, NSW, Australia
| | - Michelle Nottage
- Clinical and Research Imaging Centre, South Australian Health and Medical Research Institute, Adelaide, SA, Australia; Dr Jones and Partners Medical Imaging, Adelaide, SA, Australia
| | - Ian Kirkwood
- Department of Nuclear Medicine and PET, Royal Adelaide Hospital, Adelaide, SA, Australia; Faculty of Health and Medical Sciences, University of Adelaide, Adelaide, SA, Australia
| | - Dickon Hayne
- UWA Medical School, University of Western Australia, Perth, WA, Australia
| | - Emma Link
- Centre for Biostatistics and Clinical Trials, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia; Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, VIC, Australia
| | - Petra Marusic
- Molecular Imaging and Therapeutic Nuclear Medicine, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia
| | - Anetta Matera
- Centre for Biostatistics and Clinical Trials, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia
| | - Alan Herschtal
- Centre for Biostatistics and Clinical Trials, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia
| | - Amir Iravani
- Molecular Imaging and Therapeutic Nuclear Medicine, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia; Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, VIC, Australia
| | - Rodney J Hicks
- Molecular Imaging and Therapeutic Nuclear Medicine, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia; Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, VIC, Australia
| | - Scott Williams
- Division of Radiation Oncology, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia; Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, VIC, Australia; Australian and New Zealand Urogenital and Prostate Cancer Trials Group, NSW, Australia
| | - Declan G Murphy
- Division of Cancer Surgery, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia; Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, VIC, Australia
| |
Collapse
|
5
|
Hofman M, Murphy DG, Williams S, Nzenza T, Herschtal A, Matera A, Marusic P, De Abreu Lourenco R, Bailey DL, Iravani A, Hicks RJ, Francis RJ, Lawrentschuk N. The “ProPSMA Study” clinical trial protocol: A prospective randomized multi-center study of the impact of Ga-68 PSMA PET/CT imaging for staging high-risk prostate cancer prior to curative-intent surgery or radiotherapy. J Clin Oncol 2019. [DOI: 10.1200/jco.2019.37.7_suppl.tps138] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
TPS138 Background: Disease persistence or relapse following curative-intent surgery or radiotherapy of high-risk prostate cancer is not uncommon. This is attributable, in part, to a failure of accurate staging with diagnostic imaging being insensitive for detection of small volume metastatic disease. Prostate-specific-membrane-antigen (PSMA) positron emission tomography/computed tomography (PET/CT) is a new whole body scanning technique that enables visualisation of prostate cancer with high sensitivity. The hypotheses of this study are that PSMA-PET/CT (a) has improved diagnostic accuracy compared to conventional imaging, (b) should be used as a first-line diagnostic test for staging, (c) the improved diagnostic accuracy will result in significant management impact and (d) provides economic benefits when incorporated into the management algorithm. Methods: This is a 300 patient phase III multi-centre randomized study of patients with untreated high-risk prostate cancer defined by Gleason grade group 3-5, PSA ≥ 20ng/ml or clinical stage ≥ T3. Patients are randomized to Gallium-68-PSMA11 PET/CT or conventional imaging, consisting of computer tomography of the abdomen/pelvis and bone scintigraphy with SPECT/CT. Patients with negative, equivocal or oligometastatic disease cross-over to receive the other imaging arm. The primary objective is to compare the accuracy of PSMA-PET/CT to conventional imaging for detecting nodal or distant metastatic disease. Accuracy is defined by a pre-defined “ground truth” scoring system incorporating histopathologic, imaging and clinical follow-up at six months post randomisation. Secondary objectives include comparing management impact, the number of equivocal studies, the incremental value of second-line imaging in patients who cross-over, health economics, radiation exposure, inter-observer agreement and safety of PSMA-PET/CT. Longer term follow-up will also assess the prognostic value of a negative PSMA-PET/CT. 294 of 300 (98%) patients randomised at time of abstract submission. Clinical trial information: 12617000005358.
Collapse
Affiliation(s)
| | | | | | | | - Alan Herschtal
- Centre for Biostatistics and Clinical Trials, Peter MacCallum Cancer Centre, Melbourne, Australia
| | | | | | | | | | - Amir Iravani
- Peter MacCallum Cancer Centre, Melbourne, Australia
| | | | | | | |
Collapse
|
6
|
Schmitt F, Aurlien H, Brøgger J, Hirsch L, Schomer D, Trinka E, Pressler R, Wennberg R, Visser G, Eisermann M, Diehl B, Lesser R, Kaplan P, The Tich S, Lee J, Martins-da-Silva A, Stefan H, Neufeld M, Rubboli G, Fabricius M, Gardella E, Terney D, Meritam P, Eichele T, Asano E, Cox F, van Emde Boas W, Mameniskiene R, Marusic P, Zárubová J, Rosén I, Fuglsang-Frederiksen A, Ikeda A, MacDonald D, Terada K, Ugawa Y, Zhou D, Herman S, Beniczky S. Standardisierter Computer-basiert-organisierter Report des EEG (SCORE) – Eine strukturierende Form der EEG-Befundung. KLIN NEUROPHYSIOL 2018. [DOI: 10.1055/s-0043-125304] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
ZusammenfassungEine 2013 von der „International Federation of Clinical Neurophysiology“ gegründete Taskforce hat eine international konsensfähige EEG-Terminologie entwickelt. Im Folgenden soll das Resultat – die 2. Version des Standardized Computer-based Organized Reporting of EEG (SCORE) - vorgestellt werden. Die Terminologie wurde im Rahmen eines Softwarepaketes (SCORE-EEG) in der klinischen Praxis an über 12.000 EEGs getestet. Die Auswahl der Begriffe ist kontextabhängig: die initiale Auswahl bestimmt, welche weiteren Auswahlmöglichkeiten zur Verfügung stehen. Im Verlauf wird automatisch ein Befund erstellt und dessen Einzelmerkmale in eine Datenbank eingespeist. SCORE verfügt über Module spezifisch für die Befundung epileptischer Anfälle, sowie charakteristischer neonataler und intensivmedizinische EEG-Merkmale. SCORE ist nicht nur ein nützliches Werkzeug im ambulanten, klinischen und wissenschaftlichen Setting, es erleichtert auch Qualitätssicherung, Datenaustausch und die EEG-Aus und Weiterbildung.
Collapse
Affiliation(s)
- F Schmitt
- Universitätsklinik für Neurologie, Otto-von-Guericke Universität, Magdeburg, Deutschland
| | - H Aurlien
- Department of Neurology, Haukeland University Hospital and Department of Clinical Medicine, University of Bergen, Bergen, Norwegen
| | - J Brøgger
- Department of Neurology, Haukeland University Hospital and Department of Clinical Medicine, University of Bergen, Bergen, Norwegen
| | - L Hirsch
- Comprehensive Epilepsy Center, Yale University School of Medicine, New Haven, CT, USA
| | - D Schomer
- Department of Neurology, Laboratory of Clinical Neurophysiology, Beth Israel Deaconess Medical Center, Harvard University, Boston, MA, USA
| | - E Trinka
- Universitätskliniklinik für Neurologie, Christian Doppler Klinik, Paracelsus Medizinische Universität und Zentrum für Kognitive Neurowissenschaften Salzburg, Österreich und Institut für Public Health, Versorgungsforschung & HTA, UMIT, Hall in Tirol, Österreich
| | - R Pressler
- Department of Clinical Neurophysiology, Great Ormond Street Hospital und Clinical Neuroscience, UCL Great Ormond Street Institute of Child Health, London, Großbritannien
| | - R Wennberg
- Krembil Neuroscience Centre, Toronto Western Hospital, University of Toronto, Toronto, Ontario, Kanada
| | - G Visser
- Department of Clinical Neurophysiology, Stichting Epilepsie Instellingen Nederland (SEIN), Niederlande
| | - M Eisermann
- Department of Clinical Neurophysiology, Necker Enfants Malades Hospital, Paris, Frankreich und INSERM U1129, Paris, France, Paris Descartes University, CEA, Gif sur Yvette, Paris, Frankreich
| | - B Diehl
- University College London, Department of Clinical and Experimental Epilepsy, Queen Square, London, Großbritannien
| | - R Lesser
- Johns Hopkins Medical Institutions, Baltimore, MD, USA
| | - P Kaplan
- Johns Hopkins University School of Medicine, Baltimore, Maryland, MD, USA
| | - S The Tich
- Department of Pediatric Neurology, University Hospital of Lille, Lille, Frankreich
| | - J Lee
- Department of Neurology, Brigham and Women’s Hospital, Boston, MA, USA
| | - A Martins-da-Silva
- Department of Neurophysiology, Hospital Santo António and UMIB/ICBAS – University of Porto, Porto, Portugal
| | - H Stefan
- Abteilung für Neurologie und Biomagnetismus, Universitätsklinikum Erlangen, Deutschland
| | - M Neufeld
- Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - G Rubboli
- Department of Neurology, Danish Epilepsy Center, Dianalund and University of Copenhagen, Kopenhagen, Dänemark
| | - M Fabricius
- Department of Clinical Neurophysiology, Rigshospitalet, Kopenhagen, Dänemark
| | - E Gardella
- University of Southern Denmark, Odense, Dänemark
- Department of Clinical Neurophysiology, Danish Epilepsy Centre, Dianalund, Dänemark
| | - D Terney
- Department of Clinical Neurophysiology, Danish Epilepsy Centre, Dianalund, Dänemark
| | - P Meritam
- Department of Clinical Neurophysiology, Danish Epilepsy Centre, Dianalund, Dänemark
| | - T Eichele
- Department of Neurology, Haukeland University Hospital and Department of Biological and Medical Psychology, University of Bergen, Norwegen
| | - E Asano
- Departments of Pediatrics and Neurology, Children’s Hospital of Michigan, Wayne State University, Detroit, Michigan, US
| | - F Cox
- Department of Clinical Neurophysiology, Stichting Epilepsie Instellingen Nederland (SEIN), Niederlande
| | - W van Emde Boas
- Department of Clinical Neurophysiology, Stichting Epilepsie Instellingen Nederland (SEIN), Niederlande
| | - R Mameniskiene
- Department of Neurology and Neurosurgery, Center for Neurology, Vilnius University, Vilnius, Litauen
| | - P Marusic
- Department of Neurology, Charles University, 2nd Faculty of Medicine, Motol University Hospital, Tschechische Republik
| | - J Zárubová
- Department of Neurology, Charles University, 2nd Faculty of Medicine, Motol University Hospital, Tschechische Republik
| | - I Rosén
- Department of Clinical Sciences, University of Lund, Lund, Schweden
| | | | - A Ikeda
- Department of Epilepsy, Movement Disorders and Physiology Kyoto University Graduate School of Medicine Shogoin, Sakyo-ku Kyoto, Japan
| | - D MacDonald
- Department of Neurosciences, King Faisal Specialist Hospital & Research Center, Riyadh, Saudi Arabien
| | - K Terada
- Department of Neurology, Shizuoka Institute of Epilepsy and Neurological Disorders, Shizuoka, Japan
| | - Y Ugawa
- Department of Neurology, School of Medicine, Fukushima Medical University, Fukushima, Japan
| | - D Zhou
- Department of Neurology, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - S Herman
- Department of Neurology, Laboratory of Clinical Neurophysiology, Beth Israel Deaconess Medical Center, Harvard University, Boston, MA, USA
| | - S Beniczky
- Department of Clinical Neurophysiology, Danish Epilepsy Centre, Dianalund, Dänemark
- Department of Clinical Neurophysiology, Aarhus University, Aarhus, Dänemark
| |
Collapse
|
7
|
Völker M, Berberich S, Fiederer L, Hammer J, Kršek P, Tomášek M, Marusic P, Reinacher P, Coenen V, Schulze-Bonhage A, Burgard W, Ball T. PB 13 Errors elicit high-gamma responses in the human cerebral cortex. Clin Neurophysiol 2017. [DOI: 10.1016/j.clinph.2017.06.069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
|
8
|
Eikelis N, Hering D, Marusic P, Duval J, Hammond LJ, Walton AS, Lambert EA, Esler MD, Lambert GW, Schlaich MP. The Effect of Renal Denervation on Plasma Adipokine Profile in Patients with Treatment Resistant Hypertension. Front Physiol 2017; 8:369. [PMID: 28611687 PMCID: PMC5447749 DOI: 10.3389/fphys.2017.00369] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2017] [Accepted: 05/18/2017] [Indexed: 12/16/2022] Open
Abstract
Background: We previously demonstrated the effectiveness of renal denervation (RDN) to lower blood pressure (BP) at least partially via the reduction of sympathetic stimulation to the kidney. A number of adipocyte-derived factors are implicated in BP control in obesity. Aim: The aim of this study was to examine whether RDN may have salutary effects on the adipokine profile in patients with resistant hypertension (RH). Methods: Fifty seven patients with RH undergoing RDN program have been included in this study (65% males, age 60.8 ± 1.5 years, BMI 32.6 ± 0.7 kg/m2, mean ± SEM). Throughout the study, the patients were on an average of 4.5 ± 2.7 antihypertensive drugs. Automated seated office BP measurements and plasma concentrations of leptin, insulin, non-esterified fatty acids (NEFA), adiponectin and resistin were assessed at baseline and the 3 months after RDN. Results: There was a significant reduction in mean office systolic (168.75 ± 2.57 vs. 155.23 ± 3.17 mmHg, p < 0.001) and diastolic (90.68 ± 2.31 vs. 83.74 ± 2.36 mmHg, p < 0.001) BP 3 months after RDN. Body weight, plasma leptin and resistin levels and heart rate remained unchanged. Fasting insulin concentration significantly increased 3 months after the procedure (20.05 ± 1.46 vs. 29.70 ± 2.51 uU/ml, p = 0.002). There was a significant drop in circulating NEFA at follow up (1.01 ± 0.07 vs. 0.47 ± 0.04 mEq/l, p < 0.001). Adiponectin concentration was significantly higher after RDN (5,654 ± 800 vs. 6,644 ± 967 ng/ml, p = 0.024). Conclusions: This is the first study to demonstrate that RDN is associated with potentially beneficial effects on aspects of the adipokine profile. Increased adiponectin and reduced NEFA production may contribute to BP reduction via an effect on metabolic pathways. Clinical Trial Registration Number: NCT00483808, NCT00888433.
Collapse
Affiliation(s)
- Nina Eikelis
- Human Neurotransmitters and Neurovascular Hypertension and Kidney Disease Laboratories, Baker Heart and Diabetes InstituteMelbourne, VIC, Australia.,Iverson Health Innovation Research Institute, Swinburne University of TechnologyMelbourne, VIC, Australia
| | - Dagmara Hering
- Human Neurotransmitters and Neurovascular Hypertension and Kidney Disease Laboratories, Baker Heart and Diabetes InstituteMelbourne, VIC, Australia.,School of Medicine and Pharmacology - Royal Perth Hospital Unit, University of Western AustraliaPerth, WA, Australia
| | - Petra Marusic
- Human Neurotransmitters and Neurovascular Hypertension and Kidney Disease Laboratories, Baker Heart and Diabetes InstituteMelbourne, VIC, Australia.,School of Medicine and Pharmacology - Royal Perth Hospital Unit, University of Western AustraliaPerth, WA, Australia
| | - Jacqueline Duval
- Human Neurotransmitters and Neurovascular Hypertension and Kidney Disease Laboratories, Baker Heart and Diabetes InstituteMelbourne, VIC, Australia
| | - Louise J Hammond
- Human Neurotransmitters and Neurovascular Hypertension and Kidney Disease Laboratories, Baker Heart and Diabetes InstituteMelbourne, VIC, Australia
| | | | - Elisabeth A Lambert
- Human Neurotransmitters and Neurovascular Hypertension and Kidney Disease Laboratories, Baker Heart and Diabetes InstituteMelbourne, VIC, Australia.,Iverson Health Innovation Research Institute, Swinburne University of TechnologyMelbourne, VIC, Australia
| | - Murray D Esler
- Human Neurotransmitters and Neurovascular Hypertension and Kidney Disease Laboratories, Baker Heart and Diabetes InstituteMelbourne, VIC, Australia.,Heart Centre Alfred HospitalMelbourne, VIC, Australia
| | - Gavin W Lambert
- Human Neurotransmitters and Neurovascular Hypertension and Kidney Disease Laboratories, Baker Heart and Diabetes InstituteMelbourne, VIC, Australia.,Iverson Health Innovation Research Institute, Swinburne University of TechnologyMelbourne, VIC, Australia
| | - Markus P Schlaich
- Human Neurotransmitters and Neurovascular Hypertension and Kidney Disease Laboratories, Baker Heart and Diabetes InstituteMelbourne, VIC, Australia.,School of Medicine and Pharmacology - Royal Perth Hospital Unit, University of Western AustraliaPerth, WA, Australia.,Heart Centre Alfred HospitalMelbourne, VIC, Australia
| |
Collapse
|
9
|
Zaldivia MTK, Rivera J, Hering D, Marusic P, Sata Y, Lim B, Eikelis N, Lee R, Lambert GW, Esler MD, Htun NM, Duval J, Hammond L, Eisenhardt SU, Flierl U, Schlaich MP, Peter K. Renal Denervation Reduces Monocyte Activation and Monocyte-Platelet Aggregate Formation: An Anti-Inflammatory Effect Relevant for Cardiovascular Risk. Hypertension 2016; 69:323-331. [PMID: 27956575 DOI: 10.1161/hypertensionaha.116.08373] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2016] [Revised: 09/17/2016] [Accepted: 11/16/2016] [Indexed: 02/06/2023]
Abstract
Overactivation of renal sympathetic nervous system and low-grade systemic inflammation are common features of hypertension. Renal denervation (RDN) reduces sympathetic activity in patients with resistant hypertension. However, its effect on systemic inflammation has not been examined. We prospectively investigated the effect of RDN on monocyte activation and inflammation in patients with uncontrolled hypertension scheduled for RDN. Ambulatory blood pressure, monocyte, and monocyte subset activation and inflammatory markers were assessed at baseline, 3 months, and 6 months after procedure in 42 patients. RDN significantly lowered blood pressure at 3 months (150.5±11.2/81.0±11.2 mm Hg to 144.7±11.8/77.9±11.0 mm Hg), which was sustained at 6 months (144.7±13.8/78.6±11.0 mm Hg). Activation status of monocytes significantly decreased at 3 months (P<0.01) and 6 months (P<0.01) after the procedure. In particular, classical monocyte activation was reduced at 6 months (P<0.05). Similarly, we observed a reduction of several inflammatory markers, including monocyte-platelet aggregates (3 months, P<0.01), plasma monocyte chemoattractant protein-1 levels (3 months, P<0.0001; 6 months, P<0.05), interleukin-1β (3 months, P<0.05; 6 months, P<0.05), tumor necrosis factor-α (3 months, P<0.01; 6 months, P<0.05), and interleukin-12 (3 months, P<0.01; 6 months, P<0.05). A positive correlation was observed between muscle sympathetic nerve activity and monocyte activation before and after the procedure. These results indicate that inhibition of sympathetic activity via RDN is associated with a reduction of monocyte activation and other inflammatory markers in hypertensive patients. These findings point to a direct interaction between the inflammatory and sympathetic nervous system, which is of central relevance for the understanding of beneficial cardiovascular effects of RDN.
Collapse
Affiliation(s)
- Maria T K Zaldivia
- From the Atherothrombosis and Vascular Biology (M.T.K.Z., J.R., B.L., N.M.H., S.U.E., U.F., K.P.) and Neurovascular Hypertension and Kidney Disease Laboratory (D.H., P.M., Y.S., N.E., R.L., G.W.L., M.D.E., J.D., L.H., M.P.S.), Baker IDI Heart and Diabetes Institute, Melbourne, Australia; Department of Medicine, Monash University, Melbourne (M.T.K.Z., N.M.H., M.P.S., K.P.); Dobney Hypertension Centre, School of Medicine and Pharmacology-Royal Perth Hospital Unit, University of Western Australia, Australia (D.H., P.M., M.P.S.); and Department of Plastic and Hand Surgery, University Medical Centre, Freiburg, Germany (S.U.E.)
| | - Jennifer Rivera
- From the Atherothrombosis and Vascular Biology (M.T.K.Z., J.R., B.L., N.M.H., S.U.E., U.F., K.P.) and Neurovascular Hypertension and Kidney Disease Laboratory (D.H., P.M., Y.S., N.E., R.L., G.W.L., M.D.E., J.D., L.H., M.P.S.), Baker IDI Heart and Diabetes Institute, Melbourne, Australia; Department of Medicine, Monash University, Melbourne (M.T.K.Z., N.M.H., M.P.S., K.P.); Dobney Hypertension Centre, School of Medicine and Pharmacology-Royal Perth Hospital Unit, University of Western Australia, Australia (D.H., P.M., M.P.S.); and Department of Plastic and Hand Surgery, University Medical Centre, Freiburg, Germany (S.U.E.)
| | - Dagmara Hering
- From the Atherothrombosis and Vascular Biology (M.T.K.Z., J.R., B.L., N.M.H., S.U.E., U.F., K.P.) and Neurovascular Hypertension and Kidney Disease Laboratory (D.H., P.M., Y.S., N.E., R.L., G.W.L., M.D.E., J.D., L.H., M.P.S.), Baker IDI Heart and Diabetes Institute, Melbourne, Australia; Department of Medicine, Monash University, Melbourne (M.T.K.Z., N.M.H., M.P.S., K.P.); Dobney Hypertension Centre, School of Medicine and Pharmacology-Royal Perth Hospital Unit, University of Western Australia, Australia (D.H., P.M., M.P.S.); and Department of Plastic and Hand Surgery, University Medical Centre, Freiburg, Germany (S.U.E.)
| | - Petra Marusic
- From the Atherothrombosis and Vascular Biology (M.T.K.Z., J.R., B.L., N.M.H., S.U.E., U.F., K.P.) and Neurovascular Hypertension and Kidney Disease Laboratory (D.H., P.M., Y.S., N.E., R.L., G.W.L., M.D.E., J.D., L.H., M.P.S.), Baker IDI Heart and Diabetes Institute, Melbourne, Australia; Department of Medicine, Monash University, Melbourne (M.T.K.Z., N.M.H., M.P.S., K.P.); Dobney Hypertension Centre, School of Medicine and Pharmacology-Royal Perth Hospital Unit, University of Western Australia, Australia (D.H., P.M., M.P.S.); and Department of Plastic and Hand Surgery, University Medical Centre, Freiburg, Germany (S.U.E.)
| | - Yusuke Sata
- From the Atherothrombosis and Vascular Biology (M.T.K.Z., J.R., B.L., N.M.H., S.U.E., U.F., K.P.) and Neurovascular Hypertension and Kidney Disease Laboratory (D.H., P.M., Y.S., N.E., R.L., G.W.L., M.D.E., J.D., L.H., M.P.S.), Baker IDI Heart and Diabetes Institute, Melbourne, Australia; Department of Medicine, Monash University, Melbourne (M.T.K.Z., N.M.H., M.P.S., K.P.); Dobney Hypertension Centre, School of Medicine and Pharmacology-Royal Perth Hospital Unit, University of Western Australia, Australia (D.H., P.M., M.P.S.); and Department of Plastic and Hand Surgery, University Medical Centre, Freiburg, Germany (S.U.E.)
| | - Bock Lim
- From the Atherothrombosis and Vascular Biology (M.T.K.Z., J.R., B.L., N.M.H., S.U.E., U.F., K.P.) and Neurovascular Hypertension and Kidney Disease Laboratory (D.H., P.M., Y.S., N.E., R.L., G.W.L., M.D.E., J.D., L.H., M.P.S.), Baker IDI Heart and Diabetes Institute, Melbourne, Australia; Department of Medicine, Monash University, Melbourne (M.T.K.Z., N.M.H., M.P.S., K.P.); Dobney Hypertension Centre, School of Medicine and Pharmacology-Royal Perth Hospital Unit, University of Western Australia, Australia (D.H., P.M., M.P.S.); and Department of Plastic and Hand Surgery, University Medical Centre, Freiburg, Germany (S.U.E.)
| | - Nina Eikelis
- From the Atherothrombosis and Vascular Biology (M.T.K.Z., J.R., B.L., N.M.H., S.U.E., U.F., K.P.) and Neurovascular Hypertension and Kidney Disease Laboratory (D.H., P.M., Y.S., N.E., R.L., G.W.L., M.D.E., J.D., L.H., M.P.S.), Baker IDI Heart and Diabetes Institute, Melbourne, Australia; Department of Medicine, Monash University, Melbourne (M.T.K.Z., N.M.H., M.P.S., K.P.); Dobney Hypertension Centre, School of Medicine and Pharmacology-Royal Perth Hospital Unit, University of Western Australia, Australia (D.H., P.M., M.P.S.); and Department of Plastic and Hand Surgery, University Medical Centre, Freiburg, Germany (S.U.E.)
| | - Rebecca Lee
- From the Atherothrombosis and Vascular Biology (M.T.K.Z., J.R., B.L., N.M.H., S.U.E., U.F., K.P.) and Neurovascular Hypertension and Kidney Disease Laboratory (D.H., P.M., Y.S., N.E., R.L., G.W.L., M.D.E., J.D., L.H., M.P.S.), Baker IDI Heart and Diabetes Institute, Melbourne, Australia; Department of Medicine, Monash University, Melbourne (M.T.K.Z., N.M.H., M.P.S., K.P.); Dobney Hypertension Centre, School of Medicine and Pharmacology-Royal Perth Hospital Unit, University of Western Australia, Australia (D.H., P.M., M.P.S.); and Department of Plastic and Hand Surgery, University Medical Centre, Freiburg, Germany (S.U.E.)
| | - Gavin W Lambert
- From the Atherothrombosis and Vascular Biology (M.T.K.Z., J.R., B.L., N.M.H., S.U.E., U.F., K.P.) and Neurovascular Hypertension and Kidney Disease Laboratory (D.H., P.M., Y.S., N.E., R.L., G.W.L., M.D.E., J.D., L.H., M.P.S.), Baker IDI Heart and Diabetes Institute, Melbourne, Australia; Department of Medicine, Monash University, Melbourne (M.T.K.Z., N.M.H., M.P.S., K.P.); Dobney Hypertension Centre, School of Medicine and Pharmacology-Royal Perth Hospital Unit, University of Western Australia, Australia (D.H., P.M., M.P.S.); and Department of Plastic and Hand Surgery, University Medical Centre, Freiburg, Germany (S.U.E.)
| | - Murray D Esler
- From the Atherothrombosis and Vascular Biology (M.T.K.Z., J.R., B.L., N.M.H., S.U.E., U.F., K.P.) and Neurovascular Hypertension and Kidney Disease Laboratory (D.H., P.M., Y.S., N.E., R.L., G.W.L., M.D.E., J.D., L.H., M.P.S.), Baker IDI Heart and Diabetes Institute, Melbourne, Australia; Department of Medicine, Monash University, Melbourne (M.T.K.Z., N.M.H., M.P.S., K.P.); Dobney Hypertension Centre, School of Medicine and Pharmacology-Royal Perth Hospital Unit, University of Western Australia, Australia (D.H., P.M., M.P.S.); and Department of Plastic and Hand Surgery, University Medical Centre, Freiburg, Germany (S.U.E.)
| | - Nay M Htun
- From the Atherothrombosis and Vascular Biology (M.T.K.Z., J.R., B.L., N.M.H., S.U.E., U.F., K.P.) and Neurovascular Hypertension and Kidney Disease Laboratory (D.H., P.M., Y.S., N.E., R.L., G.W.L., M.D.E., J.D., L.H., M.P.S.), Baker IDI Heart and Diabetes Institute, Melbourne, Australia; Department of Medicine, Monash University, Melbourne (M.T.K.Z., N.M.H., M.P.S., K.P.); Dobney Hypertension Centre, School of Medicine and Pharmacology-Royal Perth Hospital Unit, University of Western Australia, Australia (D.H., P.M., M.P.S.); and Department of Plastic and Hand Surgery, University Medical Centre, Freiburg, Germany (S.U.E.)
| | - Jacqueline Duval
- From the Atherothrombosis and Vascular Biology (M.T.K.Z., J.R., B.L., N.M.H., S.U.E., U.F., K.P.) and Neurovascular Hypertension and Kidney Disease Laboratory (D.H., P.M., Y.S., N.E., R.L., G.W.L., M.D.E., J.D., L.H., M.P.S.), Baker IDI Heart and Diabetes Institute, Melbourne, Australia; Department of Medicine, Monash University, Melbourne (M.T.K.Z., N.M.H., M.P.S., K.P.); Dobney Hypertension Centre, School of Medicine and Pharmacology-Royal Perth Hospital Unit, University of Western Australia, Australia (D.H., P.M., M.P.S.); and Department of Plastic and Hand Surgery, University Medical Centre, Freiburg, Germany (S.U.E.)
| | - Louise Hammond
- From the Atherothrombosis and Vascular Biology (M.T.K.Z., J.R., B.L., N.M.H., S.U.E., U.F., K.P.) and Neurovascular Hypertension and Kidney Disease Laboratory (D.H., P.M., Y.S., N.E., R.L., G.W.L., M.D.E., J.D., L.H., M.P.S.), Baker IDI Heart and Diabetes Institute, Melbourne, Australia; Department of Medicine, Monash University, Melbourne (M.T.K.Z., N.M.H., M.P.S., K.P.); Dobney Hypertension Centre, School of Medicine and Pharmacology-Royal Perth Hospital Unit, University of Western Australia, Australia (D.H., P.M., M.P.S.); and Department of Plastic and Hand Surgery, University Medical Centre, Freiburg, Germany (S.U.E.)
| | - Steffen U Eisenhardt
- From the Atherothrombosis and Vascular Biology (M.T.K.Z., J.R., B.L., N.M.H., S.U.E., U.F., K.P.) and Neurovascular Hypertension and Kidney Disease Laboratory (D.H., P.M., Y.S., N.E., R.L., G.W.L., M.D.E., J.D., L.H., M.P.S.), Baker IDI Heart and Diabetes Institute, Melbourne, Australia; Department of Medicine, Monash University, Melbourne (M.T.K.Z., N.M.H., M.P.S., K.P.); Dobney Hypertension Centre, School of Medicine and Pharmacology-Royal Perth Hospital Unit, University of Western Australia, Australia (D.H., P.M., M.P.S.); and Department of Plastic and Hand Surgery, University Medical Centre, Freiburg, Germany (S.U.E.)
| | - Ulrike Flierl
- From the Atherothrombosis and Vascular Biology (M.T.K.Z., J.R., B.L., N.M.H., S.U.E., U.F., K.P.) and Neurovascular Hypertension and Kidney Disease Laboratory (D.H., P.M., Y.S., N.E., R.L., G.W.L., M.D.E., J.D., L.H., M.P.S.), Baker IDI Heart and Diabetes Institute, Melbourne, Australia; Department of Medicine, Monash University, Melbourne (M.T.K.Z., N.M.H., M.P.S., K.P.); Dobney Hypertension Centre, School of Medicine and Pharmacology-Royal Perth Hospital Unit, University of Western Australia, Australia (D.H., P.M., M.P.S.); and Department of Plastic and Hand Surgery, University Medical Centre, Freiburg, Germany (S.U.E.)
| | - Markus P Schlaich
- From the Atherothrombosis and Vascular Biology (M.T.K.Z., J.R., B.L., N.M.H., S.U.E., U.F., K.P.) and Neurovascular Hypertension and Kidney Disease Laboratory (D.H., P.M., Y.S., N.E., R.L., G.W.L., M.D.E., J.D., L.H., M.P.S.), Baker IDI Heart and Diabetes Institute, Melbourne, Australia; Department of Medicine, Monash University, Melbourne (M.T.K.Z., N.M.H., M.P.S., K.P.); Dobney Hypertension Centre, School of Medicine and Pharmacology-Royal Perth Hospital Unit, University of Western Australia, Australia (D.H., P.M., M.P.S.); and Department of Plastic and Hand Surgery, University Medical Centre, Freiburg, Germany (S.U.E.)
| | - Karlheinz Peter
- From the Atherothrombosis and Vascular Biology (M.T.K.Z., J.R., B.L., N.M.H., S.U.E., U.F., K.P.) and Neurovascular Hypertension and Kidney Disease Laboratory (D.H., P.M., Y.S., N.E., R.L., G.W.L., M.D.E., J.D., L.H., M.P.S.), Baker IDI Heart and Diabetes Institute, Melbourne, Australia; Department of Medicine, Monash University, Melbourne (M.T.K.Z., N.M.H., M.P.S., K.P.); Dobney Hypertension Centre, School of Medicine and Pharmacology-Royal Perth Hospital Unit, University of Western Australia, Australia (D.H., P.M., M.P.S.); and Department of Plastic and Hand Surgery, University Medical Centre, Freiburg, Germany (S.U.E.).
| |
Collapse
|
10
|
Hering D, Marusic P, Duval J, Sata Y, Esler M, Walton A, Schlaich M. OS 19-01 BLOOD PRESSURE INDEPENDENT EFFECTS OF RENAL DENERVATION ON THE DECLINE OF KIDNEY FUNCTION IN PATIENTS WITH CHRONIC KIDNEY DISEASE. J Hypertens 2016. [DOI: 10.1097/01.hjh.0000500502.77405.dd] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
|
11
|
Zaldivia MTK, Rivera J, Hering D, Marusic P, Marusic P, Sata Y, Eikelis N, Lee R, Lambert GW, Htun NM, Duval J, Hammond L, Eisenhardt S, Flierl U, Schlaich M, Peter K. Abstract 114: Renal Denervation Reduces Monocyte Activation: An Anti-inflammatory Effect Relevant for Cardiovascular Risk. Hypertension 2016. [DOI: 10.1161/hyp.68.suppl_1.114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background:
Over-activation of renal sympathetic nervous system and low-grade systemic inflammation are thought to be common features of hypertension. Renal Denervation (RDN) reduces sympathetic activity in patients with resistant hypertension. However, its effect on systemic inflammation has not been investigated.
Aim:
To determine the effect of RDN-induced sympathetic inhibition on monocyte activation and systemic inflammation in hypertensive patients.
Methods:
Peripheral blood was obtained from 42 patients who underwent RDN for uncontrolled blood pressure (BP) at baseline, at 3 months and 6 months post-procedure. Ambulatory BP, overall activation status of monocyte as well as monocyte subsets and inflammatory markers were assessed at each time point.
Results:
RDN significantly lowered 24-hour ambulatory BP at 3 months (150.5/81.0 mmHg to 144.7/77.9 mmHg), which was sustained at 6 months (144.7/78.6 mmHg). The overall monocyte activation was significantly decreased (3 months, 4079.4 MFI to 3182.0 MFI; 6 months, 3457.62 MFI) post-RDN, specifically in the subset of classical monocytes (6 months, 4696.8 MFI to 3958.8 MFI). In line with this, reduction of several inflammatory markers were observed, including monocyte-platelet aggregates at 3 months (34% [680 of 2000 monocyte events] to 11.85% [237 of 2000 monocyte events]) and plasma levels of MCP-1 (3 months, 144.9 pg/ml to 100.1 pg/ml; 6 months, 122.2 pg/ml), IL-1β (3 months, 18.3 pg/ml to 10.8 pg/ml; 6 months, 12.2 pg/ml), TNF-α (3 months, 167.5 pg/ml to 78.4 pg/ml; 6 months, 111.1 pg/ml), IL-12 (3 months, 59.8 pg/ml to 9.9 pg/ml; 6 months, 21.4 pg/ml) and IL-6 (3 months, 2.4 pg/ml to 1.5pg/ml; 6 months, 1.9 pg/ml). A positive correlation was observed between baseline muscle sympathetic nerve activity and monocyte activation (R=0.62) and changes observed at both time points (3 months, R=0.63; 6 months, R=0.88) post-procedure.
Conclusions:
Inhibition of sympathetic activity via RDN is associated with a reduction of monocyte activation and other circulating inflammatory markers in hypertensive patients. These findings point to a direct interaction between the inflammatory and sympathetic nervous system, which is of central relevance for the understanding of beneficial cardiovascular effects of RDN.
Collapse
Affiliation(s)
| | - Jennifer Rivera
- Baker IDI Heart and Diabetes Institute, Melbourne, Australia
| | - Dagmara Hering
- Dobney Hypertension Cntr, Sch of Medicine and Pharmacology- Royal Perth Hosp Unit, Univ of Western Australia, Perth, Australia
| | - Petra Marusic
- Dobney Hypertension Cntr, Sch of Medicine and Pharmacology- Royal Perth Hosp Unit, Univ of Western Australia, Perth, Australia
| | - Petra Marusic
- Dobney Hypertension Cntr, Sch of Medicine and Pharmacology- Royal Perth Hosp Unit, Univ of Western Australia, Perth, Australia
| | - Yusuke Sata
- Baker IDI Heart and Diabetes Institute, Melbourne, Australia
| | - Nina Eikelis
- Baker IDI Heart and Diabetes Institute, Melbourne, Australia
| | - Rebecca Lee
- Baker IDI Heart and Diabetes Institute, Melbourne, Australia
| | | | - Nay M. Htun
- Baker IDI Heart and Diabetes Institute, Melbourne, Australia
| | | | - Louise Hammond
- Baker IDI Heart and Diabetes Institute, Melbourne, Australia
| | | | - Ulrike Flierl
- Baker IDI Heart and Diabetes Institute, Melbourne, Australia
| | - Markus Schlaich
- Dobney Hypertension Cntr, Sch of Medicine and Pharmacology- Royal Perth Hosp Unit, Univ of Western Australia, Perth, Australia
| | - Karlheinz Peter
- Baker IDI Heart and Diabetes Institute, Melbourne, Australia
| |
Collapse
|
12
|
Atkinson CL, Carter HH, Naylor LH, Dawson EA, Marusic P, Hering D, Schlaich MP, Thijssen DHJ, Green DJ. Opposing effects of shear-mediated dilation and myogenic constriction on artery diameter in response to handgrip exercise in humans. J Appl Physiol (1985) 2015; 119:858-64. [PMID: 26294751 DOI: 10.1152/japplphysiol.01086.2014] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2014] [Accepted: 08/01/2015] [Indexed: 11/22/2022] Open
Abstract
While the impact of changes in blood flow and shear stress on artery function are well documented, the acute effects of increases in arterial pressure are less well described in humans. The aim of this study was to assess the effect of 30 min of elevated blood pressure, in the absence of changes in shear stress or sympathetic nervous system (SNS) activation, on conduit artery diameter. Ten healthy male subjects undertook three sessions of 30 min unilateral handgrip exercise at 5, 10, and 15% of maximal voluntary contractile (MVC) strength. Brachial artery shear rate and blood flow profiles were measured simultaneously during exercise in the active and contralateral resting arms. Bilateral brachial artery diameter was simultaneously assessed before and immediately postexercise. In a second experiment, six subjects repeated the 15% MVC condition while continuous vascular measurements were collected during muscle sympathetic nerve activity (MSNA) assessment using peroneal microneurography. We found that unilateral handgrip exercise at 5, 10, and 15% MVC strength induced stepwise elevations in blood pressure (P < 0.01, Δmean arterial pressure: 7.06 ± 2.44, 8.50 ± 2.80, and 18.35 ± 3.52 mmHg, P < 0.01). Whereas stepwise increases were evident in shear rate in the exercising arm (P < 0.001), no changes were apparent in the nonexercising limb (P = 0.42). Brachial artery diameter increased in the exercising arm (P = 0.02), but significantly decreased in the nonexercising arm (P = 0.03). At 15% MVC, changes in diameter were significantly different between arms (interaction effect: P = 0.01), whereas this level of exertion produced no significant changes in MSNA. We conclude that acute increases in transmural pressure, independent of shear rate and changes in SNS activation, reduce arterial caliber in normotensive humans in vivo. These changes in diameter were mitigated by exercise-induced elevations in shear rate in the active limb.
Collapse
Affiliation(s)
- Ceri L Atkinson
- School of Sports Science, Exercise and Health, The University of Western Australia, Crawley, Western Australia
| | - Howard H Carter
- School of Sports Science, Exercise and Health, The University of Western Australia, Crawley, Western Australia
| | - Louise H Naylor
- School of Sports Science, Exercise and Health, The University of Western Australia, Crawley, Western Australia
| | - Ellen A Dawson
- Research Institute for Sport and Exercise Science, Liverpool John Moores University, Liverpool, United Kingdom
| | - Petra Marusic
- School of Medicine and Pharmacology, The University of Western Australia, Crawley, Western Australia; and
| | - Dagmara Hering
- School of Medicine and Pharmacology, The University of Western Australia, Crawley, Western Australia; and
| | - Markus P Schlaich
- School of Medicine and Pharmacology, The University of Western Australia, Crawley, Western Australia; and
| | - Dick H J Thijssen
- Research Institute for Sport and Exercise Science, Liverpool John Moores University, Liverpool, United Kingdom; Department of Physiology, Radboud University Medical Centre, Nijmegen, Netherlands
| | - Daniel J Green
- School of Sports Science, Exercise and Health, The University of Western Australia, Crawley, Western Australia; Research Institute for Sport and Exercise Science, Liverpool John Moores University, Liverpool, United Kingdom;
| |
Collapse
|
13
|
Eikelis N, Hering D, Marusic P, Sari C, Walton A, Phillips S, Lambert E, Duval J, Krum H, Lambert G, Esler M, Schlaich M. The effect of renal denervation on endothelial function and inflammatory markers in patients with resistant hypertension. Int J Cardiol 2015; 188:96-8. [DOI: 10.1016/j.ijcard.2015.04.041] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2015] [Accepted: 04/03/2015] [Indexed: 11/26/2022]
|
14
|
McLellan AJA, Schlaich MP, Taylor AJ, Prabhu S, Hering D, Hammond L, Marusic P, Duval J, Sata Y, Ellims A, Esler M, Peter K, Shaw J, Walton A, Kalman JM, Kistler PM. Reverse cardiac remodeling after renal denervation: Atrial electrophysiologic and structural changes associated with blood pressure lowering. Heart Rhythm 2015; 12:982-90. [PMID: 25638699 DOI: 10.1016/j.hrthm.2015.01.039] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2014] [Indexed: 12/14/2022]
Abstract
BACKGROUND Hypertension is the most common modifiable risk factor associated with atrial fibrillation. OBJECTIVE The purpose of this study was to determine the effects of blood pressure (BP) lowering after renal denervation on atrial electrophysiologic and structural remodeling in humans. METHODS Fourteen patients (mean age 64 ± 9 years, duration of hypertension 16 ± 11 years, on 5 ± 2 antihypertensive medications) with treatment-resistant hypertension underwent baseline 24-hour ambulatory BP monitoring, echocardiography, cardiac magnetic resonance imaging, and electrophysiologic study. Electrophysiologic study included measurements of P-wave duration, effective refractory periods, and conduction times. Electroanatomic mapping of the right atrium was completed using CARTO3 to determine local and regional conduction velocity and tissue voltage. Bilateral renal denervation was performed, and all measurements repeated after 6 months. RESULTS After renal denervation, mean 24-hour BP reduced from 152/84 mm Hg to 141/80 mm Hg at 6-month follow-up (P < .01). Global conduction velocity increased significantly (0.98 ± 0.13 m/s to 1.2 ± 0.16 m/s at 6 months, P < .01), conduction time shortened (32 ± 5 ms to 27 ± 6 ms, P < .01), and complex fractionated activity was reduced (37% ± 14% to 19% ± 12%, P = .02). Changes in conduction velocity correlated positively with changes in 24-hour mean systolic BP (R(2) = 0.55, P = .01). There was a significant reduction in left ventricular mass (139 ± 37 g to 120 ± 29 g, P < .01) and diffuse ventricular fibrosis (T1 partition coefficient 0.39 ± 0.07 to 0.31 ± 0.09, P = .01) on cardiac magnetic resonance imaging. CONCLUSION BP reduction after renal denervation is associated with improvements in regional and global atrial conduction and reductions in ventricular mass and fibrosis. Whether changes in electrical and structural remodeling are solely due to BP lowering or are due in part to intrinsic effects of renal denervation remains to be determined.
Collapse
Affiliation(s)
- Alex J A McLellan
- Department of Cardiovascular Medicine, Alfred Hospital, Melbourne, Victoria, Australia; Baker IDI Heart and Diabetes Institute, Melbourne, Victoria, Australia; Cardiology Department, Royal Melbourne Hospital, Victoria, Australia; Faculty of Medicine, Dentistry, and Health Sciences, University of Melbourne, Victoria, Australia
| | - Markus P Schlaich
- Department of Cardiovascular Medicine, Alfred Hospital, Melbourne, Victoria, Australia; Baker IDI Heart and Diabetes Institute, Melbourne, Victoria, Australia; Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Australia; School of Medicine and Pharmacology-Royal Perth Hospital Campus, University of Western Australia, Perth, Australia
| | - Andrew J Taylor
- Department of Cardiovascular Medicine, Alfred Hospital, Melbourne, Victoria, Australia; Baker IDI Heart and Diabetes Institute, Melbourne, Victoria, Australia
| | - Sandeep Prabhu
- Department of Cardiovascular Medicine, Alfred Hospital, Melbourne, Victoria, Australia; Baker IDI Heart and Diabetes Institute, Melbourne, Victoria, Australia; Cardiology Department, Royal Melbourne Hospital, Victoria, Australia; Faculty of Medicine, Dentistry, and Health Sciences, University of Melbourne, Victoria, Australia
| | - Dagmara Hering
- Baker IDI Heart and Diabetes Institute, Melbourne, Victoria, Australia
| | - Louise Hammond
- Baker IDI Heart and Diabetes Institute, Melbourne, Victoria, Australia
| | - Petra Marusic
- Baker IDI Heart and Diabetes Institute, Melbourne, Victoria, Australia
| | - Jacqueline Duval
- Baker IDI Heart and Diabetes Institute, Melbourne, Victoria, Australia
| | - Yusuke Sata
- Baker IDI Heart and Diabetes Institute, Melbourne, Victoria, Australia
| | - Andris Ellims
- Department of Cardiovascular Medicine, Alfred Hospital, Melbourne, Victoria, Australia; Baker IDI Heart and Diabetes Institute, Melbourne, Victoria, Australia
| | - Murray Esler
- Department of Cardiovascular Medicine, Alfred Hospital, Melbourne, Victoria, Australia; Baker IDI Heart and Diabetes Institute, Melbourne, Victoria, Australia; Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Australia
| | - Karlheinz Peter
- Department of Cardiovascular Medicine, Alfred Hospital, Melbourne, Victoria, Australia; Baker IDI Heart and Diabetes Institute, Melbourne, Victoria, Australia
| | - James Shaw
- Department of Cardiovascular Medicine, Alfred Hospital, Melbourne, Victoria, Australia; Baker IDI Heart and Diabetes Institute, Melbourne, Victoria, Australia
| | - Antony Walton
- Department of Cardiovascular Medicine, Alfred Hospital, Melbourne, Victoria, Australia; Baker IDI Heart and Diabetes Institute, Melbourne, Victoria, Australia
| | - Jonathan M Kalman
- Cardiology Department, Royal Melbourne Hospital, Victoria, Australia; Faculty of Medicine, Dentistry, and Health Sciences, University of Melbourne, Victoria, Australia
| | - Peter M Kistler
- Department of Cardiovascular Medicine, Alfred Hospital, Melbourne, Victoria, Australia; Baker IDI Heart and Diabetes Institute, Melbourne, Victoria, Australia; Cardiology Department, Royal Melbourne Hospital, Victoria, Australia; Faculty of Medicine, Dentistry, and Health Sciences, University of Melbourne, Victoria, Australia.
| |
Collapse
|
15
|
Zaldivia M, Rivera J, Marusic P, McCartney D, Lee R, Htun N, Flierl U, Duval J, Hammond L, Schlaich M, Peter K. Renal denervation reduces monocyte activation in human hypertension. Heart Lung Circ 2015. [DOI: 10.1016/j.hlc.2015.06.039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
|
16
|
McLellan A, Schlaich M, Taylor A, Prabhu S, Hering D, Hammond L, Marusic P, Duval J, Sata Y, Ellims A, Peter K, Shaw J, Walton A, Kalman J, Kistler P. Reverse cardiac remodelling following renal denervation - atrial electrophysiologic and structural changes associated with blood pressure lowering. Heart Lung Circ 2015. [DOI: 10.1016/j.hlc.2015.06.321] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
|
17
|
Straznicky NE, Grima MT, Sari CI, Eikelis N, Lambert GW, Nestel PJ, Karapanagiotidis S, Wong C, Richards K, Marusic P, Dixon JB, Schlaich MP, Lambert EA. A randomized controlled trial of the effects of pioglitazone treatment on sympathetic nervous system activity and cardiovascular function in obese subjects with metabolic syndrome. J Clin Endocrinol Metab 2014; 99:E1701-7. [PMID: 24937541 DOI: 10.1210/jc.2014-1976] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
CONTEXT Insulin resistance and sympathetic nervous system overactivity are closely associated and contribute to cardiovascular risk. OBJECTIVE The objective of the study was to test the hypotheses that pharmacological improvement in insulin sensitivity would (1) attenuate sympathetic neural drive and (2) enhance neuronal norepinephrine uptake. PARTICIPANTS AND METHODS A randomized, double-blind trial was conducted in 42 obese, unmedicated individuals with metabolic syndrome (mean age 56 ± 1 y, body mass index 34 ± 0.6 kg/m(2)) who received 12 weeks of pioglitazone (PIO; 15 mg for 6 wk, then 30 mg daily) or matched placebo. Clinical measurements included whole-body norepinephrine kinetics [spillover rate, plasma clearance, and the steady state ratio of tritiated 3,4-dihydroxyphenylglycol to tritiated norepinephrine ([(3)H]-DHPG to [(3)H]-NE) as an index of neuronal uptake-1], muscle sympathetic nerve activity, spontaneous baroreflex sensitivity, euglycemic hyperinsulinemic clamp, oral glucose tolerance test, ambulatory blood pressure, and Doppler echocardiography. RESULTS PIO treatment increased glucose uptake by 35% and was accompanied by significant reductions in diastolic blood pressure and improved left ventricular diastolic and endothelial function. Resting muscle sympathetic nerve activity burst frequency decreased by -6 ± 3 burst/min compared with baseline (P = .03), but the magnitude of change was not different from placebo (P = .89). Norepinephrine spillover and clearance rates and baroreflex sensitivity were unchanged. Post hoc subgroup analyses revealed an 83% increase in [(3)H]-DHPG to [(3)H]-NE ratio in hyperinsulinemic (P = .04) but not normoinsulinemic subjects (time × group interaction, P = .045). Change in [(3)H]-DHPG to [(3)H]-NE ratio correlated with improvements in diastolic blood pressure (r = -0.67, P = .002), the ratio of early (E) to late (A) peak transmitral diastolic inflow velocity (r = 0.62, P = .008), E wave deceleration time (r = -0.48, P = .05), and Δinsulin area under the curve0-120 during the oral glucose tolerance test (r = -0.42, P = .08). CONCLUSIONS Compared with placebo, PIO does not affect resting sympathetic drive or norepinephrine disposition in obese subjects with metabolic syndrome. Treatment induced changes in the [(3)H]-DHPG to [(3)H]-NE ratio related to reduction in hyperinsulinemia and improvements in diastolic function.
Collapse
Affiliation(s)
- Nora E Straznicky
- Laboratories of Human Neurotransmitters (N.E.S., M.T.G., C.L.S., N.E., G.W.L., K.R., J.B.D., E.A.L.), Cardiovascular Nutrition (P.J.N.), and Neurovascular Hypertension and Kidney Disease (P.M., M.P.S.) and Alfred Baker Medical Unit (S.K., C.W.), Baker IDI Heart and Diabetes Institute, Melbourne, Victoria 8008, Australia; Faculty of Medicine, Nursing, and Health Sciences (G.W.L., M.P.S.) and the Departments of Physiology (E.A.L.) and Primary Health Care (J.B.D.), Monash University, Melbourne, Victoria 3800, Australia; and the Department of Physiology (E.A.L.), University of Melbourne, Melbourne 3010, Australia
| | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
18
|
Hering D, Marusic P, Walton AS, Lambert EA, Krum H, Narkiewicz K, Lambert GW, Esler MD, Schlaich MP. Sustained sympathetic and blood pressure reduction 1 year after renal denervation in patients with resistant hypertension. Hypertension 2014; 64:118-24. [PMID: 24732891 DOI: 10.1161/hypertensionaha.113.03098] [Citation(s) in RCA: 113] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Renal denervation (RDN) reduces muscle sympathetic nerve activity (MSNA) and blood pressure (BP) in resistant hypertension. Although a persistent BP-lowering effect has been demonstrated, the long-term effect on MSNA remains elusive. We investigated whether RDN influences MSNA over time. Office BP and MSNA were obtained at baseline, 3, 6, and 12 months after RDN in 35 patients with resistant hypertension. Office BP averaged 166±22/88±19 mm Hg, despite the use of an average of 4.8±2.1 antihypertensive drugs. Baseline MSNA was 51±11 bursts/min ≈2- to 3-fold higher than the level observed in healthy controls. Mean office systolic and diastolic BP significantly decreased by -12.6±18.3/-6.5±9.2, -16.1±25.6/-8.6±12.9, and -21.2±29.1/-11.1±12.9 mm Hg (P<0.001 for both systolic BP and diastolic BP) with RDN at 3-, 6-, and 12-month follow-up, respectively. MSNA was reduced by -8±12, -6±12, and -6±11 bursts/min (P<0.01) at 3-, 6-, and 12-month follow-up. The reduction in MSNA was maintained, despite a progressive fall in BP over time. No such changes were observed in 7 control subjects at 6-month follow-up. These findings confirm previous reports on the favorable effects of RDN on elevated BP and demonstrate sustained reduction of central sympathetic outflow ≤1-year follow-up in patients with resistant hypertension and high baseline MSNA. These observations are compatible with the hypothesis of a substantial contribution of afferent renal nerve signaling to increased BP in resistant hypertension and argue against a relevant reinnervation at 1 year after procedure.
Collapse
Affiliation(s)
- Dagmara Hering
- From the Neurovascular Hypertension and Kidney Disease Laboratory, Baker IDI Heart and Diabetes Institute, Melbourne, Australia (D.H., P.M., E.A.L., G.W.L., M.D.E., M.P.S.); Department of Hypertension and Diabetology, Medical University of Gdansk, Gdańsk, Poland (D.H., K.N.); Heart Centre Alfred Hospital, Melbourne, Australia (A.S.W., H.K., M.D.E., M.P.S.); and Department of Physiology, Faculty of Medicine, Nursing and Health Sciences (E.A.L., G.W.L., M.P.S.) and Department of Epidemiology and Preventive Medicine (H.K.), Monash University, Melbourne, Australia
| | - Petra Marusic
- From the Neurovascular Hypertension and Kidney Disease Laboratory, Baker IDI Heart and Diabetes Institute, Melbourne, Australia (D.H., P.M., E.A.L., G.W.L., M.D.E., M.P.S.); Department of Hypertension and Diabetology, Medical University of Gdansk, Gdańsk, Poland (D.H., K.N.); Heart Centre Alfred Hospital, Melbourne, Australia (A.S.W., H.K., M.D.E., M.P.S.); and Department of Physiology, Faculty of Medicine, Nursing and Health Sciences (E.A.L., G.W.L., M.P.S.) and Department of Epidemiology and Preventive Medicine (H.K.), Monash University, Melbourne, Australia
| | - Antony S Walton
- From the Neurovascular Hypertension and Kidney Disease Laboratory, Baker IDI Heart and Diabetes Institute, Melbourne, Australia (D.H., P.M., E.A.L., G.W.L., M.D.E., M.P.S.); Department of Hypertension and Diabetology, Medical University of Gdansk, Gdańsk, Poland (D.H., K.N.); Heart Centre Alfred Hospital, Melbourne, Australia (A.S.W., H.K., M.D.E., M.P.S.); and Department of Physiology, Faculty of Medicine, Nursing and Health Sciences (E.A.L., G.W.L., M.P.S.) and Department of Epidemiology and Preventive Medicine (H.K.), Monash University, Melbourne, Australia
| | - Elisabeth A Lambert
- From the Neurovascular Hypertension and Kidney Disease Laboratory, Baker IDI Heart and Diabetes Institute, Melbourne, Australia (D.H., P.M., E.A.L., G.W.L., M.D.E., M.P.S.); Department of Hypertension and Diabetology, Medical University of Gdansk, Gdańsk, Poland (D.H., K.N.); Heart Centre Alfred Hospital, Melbourne, Australia (A.S.W., H.K., M.D.E., M.P.S.); and Department of Physiology, Faculty of Medicine, Nursing and Health Sciences (E.A.L., G.W.L., M.P.S.) and Department of Epidemiology and Preventive Medicine (H.K.), Monash University, Melbourne, Australia
| | - Henry Krum
- From the Neurovascular Hypertension and Kidney Disease Laboratory, Baker IDI Heart and Diabetes Institute, Melbourne, Australia (D.H., P.M., E.A.L., G.W.L., M.D.E., M.P.S.); Department of Hypertension and Diabetology, Medical University of Gdansk, Gdańsk, Poland (D.H., K.N.); Heart Centre Alfred Hospital, Melbourne, Australia (A.S.W., H.K., M.D.E., M.P.S.); and Department of Physiology, Faculty of Medicine, Nursing and Health Sciences (E.A.L., G.W.L., M.P.S.) and Department of Epidemiology and Preventive Medicine (H.K.), Monash University, Melbourne, Australia
| | - Krzysztof Narkiewicz
- From the Neurovascular Hypertension and Kidney Disease Laboratory, Baker IDI Heart and Diabetes Institute, Melbourne, Australia (D.H., P.M., E.A.L., G.W.L., M.D.E., M.P.S.); Department of Hypertension and Diabetology, Medical University of Gdansk, Gdańsk, Poland (D.H., K.N.); Heart Centre Alfred Hospital, Melbourne, Australia (A.S.W., H.K., M.D.E., M.P.S.); and Department of Physiology, Faculty of Medicine, Nursing and Health Sciences (E.A.L., G.W.L., M.P.S.) and Department of Epidemiology and Preventive Medicine (H.K.), Monash University, Melbourne, Australia
| | - Gavin W Lambert
- From the Neurovascular Hypertension and Kidney Disease Laboratory, Baker IDI Heart and Diabetes Institute, Melbourne, Australia (D.H., P.M., E.A.L., G.W.L., M.D.E., M.P.S.); Department of Hypertension and Diabetology, Medical University of Gdansk, Gdańsk, Poland (D.H., K.N.); Heart Centre Alfred Hospital, Melbourne, Australia (A.S.W., H.K., M.D.E., M.P.S.); and Department of Physiology, Faculty of Medicine, Nursing and Health Sciences (E.A.L., G.W.L., M.P.S.) and Department of Epidemiology and Preventive Medicine (H.K.), Monash University, Melbourne, Australia
| | - Murray D Esler
- From the Neurovascular Hypertension and Kidney Disease Laboratory, Baker IDI Heart and Diabetes Institute, Melbourne, Australia (D.H., P.M., E.A.L., G.W.L., M.D.E., M.P.S.); Department of Hypertension and Diabetology, Medical University of Gdansk, Gdańsk, Poland (D.H., K.N.); Heart Centre Alfred Hospital, Melbourne, Australia (A.S.W., H.K., M.D.E., M.P.S.); and Department of Physiology, Faculty of Medicine, Nursing and Health Sciences (E.A.L., G.W.L., M.P.S.) and Department of Epidemiology and Preventive Medicine (H.K.), Monash University, Melbourne, Australia
| | - Markus P Schlaich
- From the Neurovascular Hypertension and Kidney Disease Laboratory, Baker IDI Heart and Diabetes Institute, Melbourne, Australia (D.H., P.M., E.A.L., G.W.L., M.D.E., M.P.S.); Department of Hypertension and Diabetology, Medical University of Gdansk, Gdańsk, Poland (D.H., K.N.); Heart Centre Alfred Hospital, Melbourne, Australia (A.S.W., H.K., M.D.E., M.P.S.); and Department of Physiology, Faculty of Medicine, Nursing and Health Sciences (E.A.L., G.W.L., M.P.S.) and Department of Epidemiology and Preventive Medicine (H.K.), Monash University, Melbourne, Australia.
| |
Collapse
|
19
|
Martinkovic L, Kalina A, Adam J, Marusic P. MR volumetry of amygdala and hippocampus in healthy controls. J Neurol Sci 2013. [DOI: 10.1016/j.jns.2013.07.2394] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
|
20
|
Lambert GW, Hering D, Esler MD, Marusic P, Lambert EA, Tanamas SK, Shaw J, Krum H, Dixon JB, Barton DA, Schlaich MP. Response to Quality of Life After Renal Denervation. Hypertension 2013; 61:e39. [DOI: 10.1161/hypertensionaha.113.01042] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
| | - Dagmara Hering
- Baker IDI Heart and Diabetes InstituteMelbourne, Australia
| | | | - Petra Marusic
- Baker IDI Heart and Diabetes InstituteMelbourne, Australia
| | | | | | - Jonathan Shaw
- Baker IDI Heart and Diabetes InstituteMelbourne, Australia
| | - Henry Krum
- Department of Epidemiology and Preventive MedicineMonash UniversityMelbourne, Australia
| | - John B. Dixon
- Baker IDI Heart and Diabetes InstituteMelbourne, Australia
| | | | | |
Collapse
|
21
|
Schlaich MP, Bart B, Hering D, Walton A, Marusic P, Mahfoud F, Böhm M, Lambert EA, Krum H, Sobotka PA, Schmieder RE, Ika-Sari C, Eikelis N, Straznicky N, Lambert GW, Esler MD. Feasibility of catheter-based renal nerve ablation and effects on sympathetic nerve activity and blood pressure in patients with end-stage renal disease. Int J Cardiol 2013; 168:2214-20. [PMID: 23453868 DOI: 10.1016/j.ijcard.2013.01.218] [Citation(s) in RCA: 91] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2012] [Revised: 12/03/2012] [Accepted: 01/18/2013] [Indexed: 12/11/2022]
Abstract
BACKGROUND AND OBJECTIVES Sympathetic activation is a hallmark of ESRD and adversely affects cardiovascular prognosis. Efferent sympathetic outflow and afferent neural signalling from the failing native kidneys are key mediators and can be targeted by renal denervation (RDN). Whether this is feasible and effective in ESRD is not known. DESIGN, SETTING, PARTICIPANTS AND MEASUREMENTS In an initial safety and proof-of-concept study we attempted to perform RDN in 12 patients with ESRD and uncontrolled blood pressure (BP). Standardized BP measurements were obtained in all patients on dialysis free days at baseline and follow up. Measures of renal noradrenaline spillover and muscle sympathetic nerve activity were available from 5 patients at baseline and from 2 patients at 12 month follow up and beyond. RESULTS Average office BP was 170.8 ± 16.9/89.2 ± 12.1 mmHg despite the use of 3.8 ± 1.4 antihypertensive drugs. All 5 patients in whom muscle sympathetic nerve activity and noradrenaline spillover was assessed at baseline displayed substantially elevated levels. Three out of 12 patients could not undergo RDN due to atrophic renal arteries. Compared to baseline, office systolic BP was significantly reduced at 3, 6, and 12 months after RDN (from 166 ± 16.0 to 148 ± 11, 150 ± 14, and 138 ± 17 mmHg, respectively), whereas no change was evident in the 3 non-treated patients. Sympathetic nerve activity was substantially reduced in 2 patients who underwent repeat assessment. CONCLUSIONS RDN is feasible in patients with ESRD and associated with a sustained reduction in systolic office BP. Atrophic renal arteries may pose a problem for application of this technology in some patients with ESRD.
Collapse
Affiliation(s)
- Markus P Schlaich
- Neurovascular Hypertension & Kidney Disease and Human Neurotransmitters Laboratories Baker IDI Heart & Diabetes Institute, Alfred Hospital, Melbourne, Australia; Heart Centre, Alfred Hospital, Melbourne, Australia; Faculty of Medicine, Nursing and Health Sciences and Department of Physiology, Monash University, Melbourne, Victoria, Australia.
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
22
|
Hering D, Walton A, Lambert G, Marusic P, Lambert E, Krum H, Esler M, Schlaich M. The Effect of Renal Nerve Ablation on Blood Pressure and Sympathetic Activity One Year Post Procedure. Heart Lung Circ 2013. [DOI: 10.1016/j.hlc.2013.05.064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
|
23
|
Hering D, Lambert EA, Marusic P, Walton AS, Krum H, Lambert GW, Esler MD, Schlaich MP. Substantial reduction in single sympathetic nerve firing after renal denervation in patients with resistant hypertension. Hypertension 2012; 61:457-64. [PMID: 23172929 DOI: 10.1161/hypertensionaha.111.00194] [Citation(s) in RCA: 270] [Impact Index Per Article: 22.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Renal denervation (RDN) has been shown to reduce blood pressure (BP) and muscle sympathetic nerve activity (MSNA) in patients with resistant hypertension. The mechanisms underlying sympathetic neural inhibition are unknown. We examined whether RDN differentially influences the sympathetic discharge pattern of vasoconstrictor neurons in patients with resistant hypertension. Standardized office BP, single-unit MSNA, and multi-unit MSNA were obtained at baseline and at 3-month follow-up in 35 patients with resistant hypertension. Twenty-five patients underwent RDN, and 10 patients underwent repeated measurements without RDN (non-RDN). Baseline BP averaged 164/93 mm Hg (RDN) and 164/87 mm Hg (non-RDN) despite use of an average of 4.8 ± 0.4 and 4.4 ± 0.5 antihypertensive drugs, respectively. Mean office BP decreased significantly by -13/-6 mm Hg for systolic BP (P<0.001) and diastolic BP (P<0.05) with RDN but not in non-RDN at 3-month follow-up. RDN moderately decreased multi-unit MSNA (79 ± 3 versus 73 ± 4 bursts/100 heartbeats; P<0.05), whereas all properties of single-unit MSNA including firing rates of individual vasoconstrictor fibers (43 ± 5 versus 27 ± 3 spikes/100 heartbeats; P<0.01), firing probability (30 ± 2 versus 22 ± 2% per heartbeat; P<0.02), and multiple firing incidence of single units within a cardiac cycle (8 ± 1 versus 4 ± 1% per heartbeat; P<0.05) were substantially reduced at follow-up. BP, single-unit MSNA, and multi-unit MSNA remained unaltered in the non-RDN cohort at follow-up. RDN results in the substantial and rapid reduction in firing properties of single sympathetic vasoconstrictor fibers, this being more pronounced than multi-unit MSNA inhibition. Whether the earlier changes in single-unit firing patterns may predict long-term BP response to RDN warrants further exploration.
Collapse
Affiliation(s)
- Dagmara Hering
- Neurovascular Hypertension and Kidney Disease Laboratory, Baker IDI Heart and Diabetes Institute, Melbourne, Victoria 8008, Australia
| | | | | | | | | | | | | | | |
Collapse
|
24
|
Lambert GW, Hering D, Esler MD, Marusic P, Lambert EA, Tanamas SK, Shaw J, Krum H, Dixon JB, Barton DA, Schlaich MP. Health-related quality of life after renal denervation in patients with treatment-resistant hypertension. Hypertension 2012; 60:1479-84. [PMID: 23071129 DOI: 10.1161/hypertensionaha.112.200865] [Citation(s) in RCA: 60] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Recent studies have demonstrated the effectiveness of radiofrequency ablation of the renal sympathetic nerves in reducing blood pressure (BP) in patients with resistant hypertension. The effect of renal denervation on health-related quality of life (QoL) has not been evaluated. Using the Medical Outcomes Study 36-Item Short-Form Health Survey and Beck Depression Inventory-II, we examined QoL before and 3 months after renal denervation in patients with uncontrolled BP. For baseline comparisons, matched data were extracted from the Australian Diabetes, Obesity, and Lifestyle database. Before renal denervation, patients with resistant hypertension (n = 62) scored significantly worse in 5 of the eight 36-Item Short-Form Health Survey domains and the Mental Component Summary score. Three months after denervation (n = 40), clinic BP was reduced (change in systolic and diastolic BP, -16 ± 4 and -6 ± 2 mm Hg, respectively; P<0.01). The Mental Component Summary score improved (47.6 ± 1.1 versus 52 ± 1; P = 0.001) as a result of increases in the vitality, social function, role emotion, and mental health domains. Beck Depression Inventory scores were also improved, particularly with regard to symptoms of sadness (P = 0.01), tiredness (P<0.001), and libido (P<0.01). The magnitude of BP reduction or BP level achieved at 3 months bore no association to the change in QoL. Renal denervation was without a detrimental effect on any elements of the 36-Item Short-Form Health Survey. These results indicate that patients with severe hypertension resistant to therapy present with a marked reduction in subjective QoL. In this pre- and post-hypothesis generating study, several aspects of QoL were improved after renal denervation; however, this was not directly associated with the magnitude of BP reduction.
Collapse
Affiliation(s)
- Gavin W Lambert
- Human Neurotransmitters, Baker IDI Heart and Diabetes Institute, Melbourne, Victoria, Australia.
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
25
|
Beniczky S, Aurlien H, Fuglsang-Frederiksen A, Martinsda-Silva A, Trinka E, Visser G, Rubboli G, Hjalgrim H, Stefan H, Rosén I, Zarubova J, Dobesberger J, Alving J, Andersen K, Fabricius M, Atkins M, Neufeld M, Plouin P, Marusic P, Lees R, Pressler R, Hopfengärtner R, Brøgger J, Mameniskiene R, van Emde Boas W, Wolf P. W8.1 SCORE: ictal findings. Clin Neurophysiol 2011. [DOI: 10.1016/s1388-2457(11)60079-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
|
26
|
Aurlien H, Beniczky S, Fuglsang-Frederiksen A, Martinsda-Silva A, Trinka E, Visser G, Rubboli G, Hjalgrim H, Stefan H, Rosén I, Zarubova J, Dobesberger J, Alving J, Andersen K, Fabricius M, Atkins M, Neufeld M, Plouin P, Marusic P, Lees R, Pressler R, Hopfengärtner R, Brøgger J, Mameniskiene R, van Emde Boas W, Wolf P. W8.2 SCORE: an overview of the software. Clin Neurophysiol 2011. [DOI: 10.1016/s1388-2457(11)60080-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
|
27
|
Beniczky S, Aurlien H, Fuglsang-Frederiksen A, Martins-da-Silva A, Trinka E, Visser G, Rubboli G, Hjalgrim H, Stefan H, Rosén I, Brøgger J, Zarubova J, Dobesberger J, Alving J, Andersen K, Atkins M, Neufeld M, Plouin P, Marusic P, Lees R, Pressler R, Mameniskiene R, Hopfengärtner R, van Emde Boas W, Wolf P, Fabricius M. W8.3 SCORE: background activity, sleep and non-ictal findings. Clin Neurophysiol 2011. [DOI: 10.1016/s1388-2457(11)60081-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
|
28
|
Vargova L, Homola A, Cicanic M, Kuncova K, Krsek P, Marusic P, Sykova E, Zamecnik J. The diffusion parameters of the extracellular space are altered in focal cortical dysplasias. Neurosci Lett 2011; 499:19-23. [PMID: 21620932 DOI: 10.1016/j.neulet.2011.05.023] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2011] [Revised: 04/05/2011] [Accepted: 05/12/2011] [Indexed: 11/15/2022]
Abstract
Most hypotheses concerning the mechanisms underlying seizure activity in focal cortical dysplasia (FCD) are based on alterations in synaptic transmission and glial dysfunction. However, neurons may also communicate by extrasynaptic transmission, which was recently found to affect epileptiform activity under experimental conditions and which is mediated by the diffusion of neuroactive substances in the extracellular space (ECS). The ECS diffusion parameters were therefore determined using the real-time iontophoretic method in human neocortical tissue samples obtained from surgically treated epileptic patients. The obtained values of the extracellular space volume fraction and tortuosity were then correlated with the histologicaly assessed type of cortical malformation (FCD type I or II). While the extracellular volume remained unchanged (FCD I) or larger (FCD II) than in normal/control tissue, tortuosity was significantly increased in both types of dysplasia, indicating the presence of additional diffusion barriers and compromised diffusion, which might be another factor contributing to the epileptogenicity of FCD.
Collapse
Affiliation(s)
- L Vargova
- Department of Neuroscience and Center for Cell Therapy and Tissue Repair, 2nd Faculty of Medicine, Charles University in Prague, Prague, Czech Republic.
| | | | | | | | | | | | | | | |
Collapse
|
29
|
Smiljanic L, Papic N, Patrlj L, Marusic P, Markovic MV, Babic Z. Education and Imaging. Hepatobiliary and pancreatic: Biliary rupture of an hydatid cyst. J Gastroenterol Hepatol 2010; 25:431. [PMID: 20136994 DOI: 10.1111/j.1440-1746.2009.06183.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/09/2022]
Affiliation(s)
- L Smiljanic
- Divisions of Gastroenterology, Dubrava University Hospital, Zagreb, Croatia
| | | | | | | | | | | |
Collapse
|
30
|
Zamecnik J, Krsek P, Druga R, Marusic P, Benes V, Tichy M, Komarek V. Densities of parvalbumin-immunoreactive neurons in non-malformed hippocampal sclerosis-temporal neocortex and in cortical dysplasias. Brain Res Bull 2005; 68:474-81. [PMID: 16459206 DOI: 10.1016/j.brainresbull.2005.10.008] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2005] [Revised: 09/30/2005] [Accepted: 10/13/2005] [Indexed: 10/25/2022]
Abstract
The changes in density of inhibitory parvalbumin-immunoreactive interneurons were quantitatively studied by immunohistochemistry in a series of human neocortical samples comprising the spectrum of malformations of cortical development (MCD) encountered in epilepsy surgery and the non-malformed hippocampal sclerosis-temporal neocortex in patients with refractory temporal lobe epilepsy. The highest relative density of parvalbumin-immunoreactive cells was obtained in the control samples (n = 21). The number of parvalbumin-immunoreactive neurons was significantly decreased in non-malformed hippocampal sclerosis-temporal neocortex (n = 73, 80.5% of control values). In a proportion of the latter samples as well as in two controls we observed patchy regions of absence of parvalbumin staining. The total counts of parvalbumin-immunoreactive cells in all the categories of MCD - "mild MCD" (n = 25), focal cortical dysplasia type I (n = 19) and type II (n = 15) - were decreased representing 72.4%, 55.0% and 12.2% of control values, respectively. Significantly different parvalbumin-immunoreactive cell densities were demonstrated between the focal cortical dysplasia types IIA and IIB. In "mild MCD", we observed a more pronounced decrease of parvalbumin-immunoreactive cells in the infragranular layers. No significant differences were revealed between the temporal and extratemporal examples of analogous MCD types. This study provides evidence for reduction of inhibitory parvalbumin-immunoreactive interneurons in the epileptic neocortex affected by MCD as well as in morphologically unaffected epileptic temporal neocortex, thus representing a possible mechanism for their epileptogenicity.
Collapse
Affiliation(s)
- J Zamecnik
- Department of Pathology and Molecular Medicine, Charles University, 2nd Medical Faculty, V Uvalu 84, 150 06 Prague, Czech Republic.
| | | | | | | | | | | | | |
Collapse
|
31
|
Lischke R, Simonek J, Stolz AJ, Schützner J, Belsan T, Marusic P, Pafko P. Cyclosporine-related neurotoxicity in a patient after bilateral lung transplantation for cystic fibrosis. Transplant Proc 2005; 36:2837-9. [PMID: 15621163 DOI: 10.1016/j.transproceed.2004.09.072] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Cyclosporine (CsA) is a widely used immunosuppressant following solid organ transplantation. CsA administration is associated with a number of systemic complications, including neurotoxicity. A 33-year-old man with cystic fibrosis, who underwent bilateral lung transplantation, presented with severe neurotoxic symptoms leading to coma in association with CsA administration combined with high doses of methylprednisolone for treatment of an acute rejection episode. After discontinuation of CsA, a quick resolution of his clinical status was observed, as well as of the pathological findings on magnetic resonance imaging (MRI). CsA was replaced with tacrolimus leading to an uneventful course.
Collapse
Affiliation(s)
- R Lischke
- 3rd Department of Surgery, University Hospital Motol, Prague, Czech Republic.
| | | | | | | | | | | | | |
Collapse
|
32
|
Jiruska P, Proks J, Drbal O, Sovka P, Marusic P, Mares P. Comparison of different methods of time shift measurement in EEG. Physiol Res 2005; 54:459-65. [PMID: 15588147] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/01/2023] Open
Abstract
Digital signal processing techniques are often used for measurement of small time shifts between EEG signals. In our work we tested properties of linear cross-correlation and phase/coherence method. The last mentioned method was used in two versions. The first version used fast Fourier transform (FFT) algorithm and the second was based on autoregressive modeling with fixed or adaptive model order. Methods were compared on several testing signals mimicking real EEG signals. The accuracy index for each method was computed. Results showed that for long signal segments all methods bring comparably good results. Accuracy of FFT phase/coherence method significantly decreased when very short segments were used and also decreased with an increasing level of the additive noise. The best results were obtained with autoregressive version of phase/coherence. This method is more reliable and may be used with high accuracy even in very short signals segments and it is also resistant to additive noise.
Collapse
Affiliation(s)
- P Jiruska
- Institute of Physiology, Academy of Sciences of the Czech Republic, Vídenská 1083, CZ-142 20 Prague 4, Czech Republic.
| | | | | | | | | | | |
Collapse
|
33
|
Zámecník J, Krsek P, Marusic P, Druga R, Benes V, Tichý M, Komárek V. [Microscopic disorders of cortical development of the brain and its etiopathogenic importance for detection in patients with temporal epilepsy associated with hippocampal sclerosis]. Cesk Patol 2003; 39:178-84. [PMID: 14663930] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/27/2023]
Abstract
Hippocampal sclerosis represents a common structural basis of temporal lobe epilepsy. However, the etiological factors and mechanisms leading to its development still remain unexplained. In our study, we present neuropathological findings in the resected hippocampus and the pole of the temporal lobe in 15 patients with hippocampal sclerosis. "Initial precipitating injuries" that are thought to cause the development of hippocampal sclerosis (febrile seizures in early childhood, head injury or meningoencephalitis) were present in the history of 12 patients. In the remaining 3 cases, no predisposing factors were found. Attention was paid to the histopathological identification of disturbed neuronal migration and differentiation in the temporal lobe. These defects were observed in 7 cases; in three of these, no predisposing factors were stated in the patients' histories. We suggest that in these cases, hippocampal sclerosis arises due to previously undetected disorders of cortical development. A latent neocortical malformation may also contribute to the development of hippocampal sclerosis in patients with an initial precipitating injury in anamnensis. Histopathological examination of resected epileptic brain tissue can provide insights into the individual pathogenesis of epileptic disorders, especially by the detection of microscopic disorders of cortical development.
Collapse
Affiliation(s)
- J Zámecník
- Ustav patologie a molekulární medicíny 2. LF UK a FN v Motole, Praha
| | | | | | | | | | | | | |
Collapse
|
34
|
Heaney DC, Shorvon SD, Sander JW, Boon P, Komarek V, Marusic P, Dravet C, Perucca E, Majkowski J, Lima JL, Arroyo S, Tomson T, Ried S, van Donselaar C, Eskazan E, Peeters P, Carita P, Tjong-a-Hung I, Myon E, Taieb C. Cost minimization analysis of antiepileptic drugs in newly diagnosed epilepsy in 12 European countries. Epilepsia 2001; 41 Suppl 5:S37-44. [PMID: 11045437 DOI: 10.1111/j.1528-1157.2000.tb06044.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
A recent United Kingdom cost minimization analysis (CMA) of four antiepileptic drugs (AEDs) used to treat newly diagnosed adult epilepsy demonstrated that a new drug, lamotrigine (LTG), incurred higher costs than carbamazepine (CBZ), phenytoin (PHT), and valproate (VPA), whose costs were similar. This analysis took account of each drug's side-effect and tolerability profile. The present analysis investigated the costs of treatment with LTG, CBZ, PHT, and VPA in 12 European countries. Data were derived from published sources and from a panel of locally based experts. When no published data were available, estimates were obtained using expert opinion by a consensus method. These data were incorporated into a treatment pathway model, which considered the treatment of patients during the first 12 months after diagnosis. The primary outcome considered was seizure freedom. Randomized controlled trials demonstrate that the drugs considered are equally effective in terms of their ability to achieve seizure freedom, and thus the most appropriate form of economic evaluation is a CMA. These trials provided data on the incidence of side effects, dosages, and retention rates. The economic perspective taken was that of society as a whole and the analysis was calculated on an "intent-to-treat" basis. Only direct medical costs were considered. In each country considered, LTG was twofold to threefold more expensive than the other drugs considered. A sensitivity analysis demonstrated that varying each of the assumptions (range defined by expert panels) did not significantly alter the results obtained.
Collapse
Affiliation(s)
- D C Heaney
- National Hospital for Neurology and Neurosurgery, London, UK
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
35
|
Sonka K, Spacková N, Marusic P. [The nocturnal eating syndrome (2 case reports and polysomnography)]. Cesk Psychiatr 1993; 89:227-232. [PMID: 8403036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/22/2023]
Abstract
The nocturnal eating syndrome (NES) is a nocturnal sleep disorder caused by repeated awakening and the inability to fall a sleep again unless the patient ingests some food or drinks something. In children the NES is frequent, in adults rather rare and may be associated with various pathological conditions. The latter include in particular somnabulism, periodic movements of the lower extremities, narcolepsy, chronic triazolam intoxication, probably anorexia nervosa, and other eating disorders. The authors submit two case-histories of middle aged women (30 and 37 years old) without disturbances of the day-time eating behaviour, without obvious psychopathology where the symptomatology of NES developed slowly from the age of 14 and 25 years resp. Both patients ate at night small amounts of easily consumed foods which they went to fetch in the kitchen as often as five times per night. Their behaviour was calm and aimed. Usually they did not remember the nocturnal eating. Polysomnographic examination in both patients revealed poor sleep with frequent changes of the sleep stages, with frequent awakenings, in both patients incl. even awakening from deep NREM sleep. The authors conclude that in these two patients NES with somnabulism is involved.
Collapse
Affiliation(s)
- K Sonka
- Neurologická klinika 1. LF UK, Praha
| | | | | |
Collapse
|